To evaluate the benefit of prophylactic inguinal irradiation (PII) in anal canal squamous cell carcinoma (ASCC).
This retrospective study analyzed the outcome of 208 patients presenting with ASCC ...treated between 2000 and 2004 in four cancer centers of the south of France.
The population study included 35 T1, 86 T2, 59 T3, 20 T4, and 8 T stage unknown patients. Twenty-seven patients presented with macroscopic inguinal node involvement. Of the 181 patients with uninvolved nodes at presentation, 75 received a PII to a total dose of 45-50 Gy (PII group) and 106 did not receive PII (no PII group). Compared with the no PII group, patients in the PII group were younger (60% vs. 41% of patients age <68 years, p = 0.01) and had larger tumor (T3-4 = 46% vs. 27% p = 0.01). The other characteristics were well balanced between the two groups. Median follow-up was 61 months. Fourteen patients in the no PII group vs. 1 patient in the PII group developed inguinal recurrence. The 5-year cumulative rate of inguinal recurrence (CRIR) was 2% and 16% in PII and no PII group respectively (p = 0.006). In the no PII group, the 5-year CRIR was 12% and 30% for T1-T2 and T3-T4 respectively (p = 0.02). Overall survival, disease-specific survival, and disease-free survival were similar between the two groups. In the PII group, no Grade >2 toxicity of the lower extremity was observed.
PII with a dose of 45 Gy is safe and highly efficient to prevent inguinal recurrence and should be recommended for all T3-4 tumors. For early-stage tumors, PII should also be discussed, because the 5-year inguinal recurrence risk remains substantial when omitting PII (about 10%).
The majority of patients with prostate cancer who later develop lethal metastatic disease have high-risk localized disease at presentation, emphasizing the importance of effective treatment ...strategies at this stage. Multimodal treatment approaches that combine systemic and local therapies offer a promising strategy for improving the clinical outcomes of patients with high-risk localized prostate cancer. Combinations of neoadjuvant and adjuvant chemotherapy, hormonal therapy, or chemohormonal therapy are considered to be the standard of care in most solid tumours and should be investigated in the future for the treatment of prostate cancer to improve patient outcomes. However, although the combination of androgen deprivation therapy and radiotherapy is a standard of care in high-risk localized or locally advanced prostate cancer, the benefit of chemotherapy or chemohormonal therapy has yet to be demonstrated outside of the metastatic setting. Moreover, the benefit of neoadjuvant and/or adjuvant systemic therapies in combination with radical prostatectomy has not been proved. The development of next-generation hormonal agents, which have been approved for the treatment of castration-resistant prostate cancer, offers further therapeutic possibilities that are being assessed in early-phase clinical trials.
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Background: In castrate-resistant oligo metastatic prostate Cancer (CRoligoMPC), the benefit of metastases-directed ablative radiotherapy (MDRT) is poorly investigated. Our study retrospectively ...reviewed the cases of CR oligoMPC treated with MDRT. Methods: Patients receiving MDRT in CRoligoMPC were retrospectively reviewed. Patients were included if: they had < 5 metastases on metabolic work-up, testosterone is < 50 ng/mL, metastases received MDRT. Patients and disease's data were collected: age, Gleason score, time to metastases, time to castration resistance; medical treatments, metastases location (bone versus node); radiotherapy regimens, PSA (PSA doubling time PSADT at the time of MDRT and PSA response). Progression was assessed according to PCWG criteria. PFS and OS are defined as the time from MDRT to first progression, for PFS and death date for OS. Kaplan-Meier analysis was used to summarize time-to-event variables and curves were compared with the log-rank test. A logistic regression was used to identify predictive factors of PFS. Results: the median follow up is 25.6 months.107 patients met inclusion criteria, among those 197 metastases received MDRT. Median age at MDRT time was 73 years. Median hormonosensitivity duration was 38 months (4-225). Forty six patients had metastases at the time of hormonosensitivity and 61 developed metastases in the castration resistance (CR)period (spartan-like population). PSA doubling time at the time of MDT RT was < 12 months in 88%. A median number of 2 metastases per patient was treated (1-4), 54% had RT on bony metastases only, 38% on nodes, 8% on bone + node. In 61 patients with metastases at the time of CRPC, 34.5% received a CR systemic medication before or concomitantly to MDRT, 39% received CR medication at progression, 23.5% never received CR treatment (unknown in 3%). OS is 93% at 2 years and 81.4% at 3 years. For node-only metastases, 2y OS is 100% versus 89% for bone metastases. Median PFS is 12.6 months (IC 95% 9.6; 17). Metastases location, grade group, PSA or hormonosensitivity duration were not related to PFS in a univariate survival analysis. PFS was 10.2 months when PSA Doubling time was < 6 months, versus 18.2 months when it exceeded 6 months (NS). The PSA 50% response was studied in the Spartan like population, it was 83.4% in patients receiving MDRT AND new generation hormonotherapy; 31% in those who received MDRT without new generation hormonotherapy, and 20% in those who received MDRT at the time of progression of oligometastases occurring under new generation hormonotherapy. Conclusions: In a population of CR oligoM PC with short PSA DT, MDRT leads to a PFS of 12.6 months and to a 3y OS of 81.4%. In this setting, androgen receptor targeting agents are the standard of care. Whether adding MDRT could improve prognosis should be prospectively evaluated.
•nmCRPC is a heterogeneous stage of prostate cancer for which the challenge is to delay the onset of metastasis.•Until recently, few evidences were available to orient clinicians in the choice of ...treatment modalities.•Recent results obtained with next generation antiandrogen therapy demonstrate for the first time a survival benefit in this setting and will modify the management of nmCRPC.•New imaging technics will help improving diagnosis of prostate cancer and thus aid in determining the best treatment option.
Management of non metastatic castrate resistant prostate cancer is challenging for clinicians due to the heterogeneity of the disease and to the scarce clinical data available in this setting. Recent results obtained with the new generation hormone therapies (NGHT) apalutamide and enzalutamide bring a new perspective for the treatment strategy. The authors present here a systematic review of the treatment options.
Choline positron emission tomography/computed tomography (PET/CT) is a new imaging technique for the detection of oligometastatic (OM) prostate cancer. The aim of this study was to evaluate the ...outcomes after initial OM diagnoses; treatment, particularly metastasis-directed therapy (MDT); and determine risk groups.
This multi-center, retrospective study included patients with hormone-sensitive biological relapse after local treatment with curative intent and with fewer than six choline PET/CT metastases. The primary endpoint was biochemical relapse-free survival (bRFS). Risk groups were based on prostate-specific antigen (PSA) ≥ 0.8 ng/mL and metastatic sites at OM cancer diagnosis.
Between October 2012 and December 2016, 177 patients were included, with a median follow-up of 49.02 months. The median bRFS was 39.74 months. In multivariate analyses, bone metastases and PSA ≥ 0.8 ng/mL were associated with worse bRFS. Four risk groups (I to IV; hazard ratio HR, 5.92; 95% confidence interval CI, 1.32-26.61) were observed, with median bRFS not reached for group I (PSA < 0.8 ng/mL; node metastasis M1a), a 40.00-month bRFS for group II (PSA ≥ 0.8 ng/mL; M1a), 29.97-month bRFS for group III (bone metastasis M1b, whatever the PSA level); and 22.70-month bRFS for group IV (PSA > 0.8 ng/mL and visceral metastasis M1c). MDT plus androgen deprivation therapy (ADT) improved bRFS over MDT alone (48.36 vs. 34.16 months; HR, 2.12; 95% CI, 1.38-3.26), particularly for group II (HR, 2.09; 95% CI, 1.09-4.00), and reached a limit of significance for group III (HR, ;3.79 95% CI, 0.88- 16.38).
Prognostic group classifications were confirmed: PSA < 0.8 ng/mL and M1a showed a better outcome than patients with M1c and PSA ≥ 0.8 ng/mL. These results could facilitate patient selection for prospective clinical trials in OM prostate cancer.
This retrospective, multi-center study evaluated oligometastatic prostate cancer with regard to choline positron emission tomography/computed tomography, outcome, and determine risk groups. The study included 177 patients with a median follow-up of 49.02 months. In multivariate analysis, bone metastases and prostate-specific antigen (PSA) ≥ 0.8 ng/mL were associated with worse biological relapse-free survival. Based on metastatic site and PSA, four risk groups were identified (I to IV; hazard ratio, 5.92; 95% confidence interval, 1.32-26.61). These results could facilitate patient selection for prospective clinical trials.
•Local or regional targeted treatment has shown encouraging results in hormone sensitive metastatic PCa.•This strategy was not addressed specifically in the non-metastatic or metastatic CRPC.•Local ...or regional treatment could delay introduction of new systemic agent in CRPC and potentially limit induced resistance.•This strategy could maintain the patient’s quality of life.•High-level evidence for oncologic benefit of this treatment modality is required.
Emerging evidence from population-based and retrospective series suggests a potential improvement of clinical outcomes in metastatic prostate cancer. Moreover, metastasis-directed treatment has shown encouraging results in this setting. There is an increasing interest in exploring the potential of local therapies in advanced prostate cancer, but this has rarely been specifically addressed in the castration-resistant state, whether non-metastatic or metastatic. A review of relevant articles was performed on the oncologic benefit of local treatment of the primary tumor or metastasis-targeted treatment in castration-resistant prostate cancer patients. The main goal of this strategy is to delay introduction of a new systemic agent to maintain quality of life and potentially to limit resistance. Further investigation is required to provide high-level evidence for the oncologic benefit of this treatment modality.
The role of 18F-fluorocholine positron emission tomography/computed tomography (18F-Choline PET/CT) in different clinical situations remains controversial and current practices are very ...heterogeneous. The aim of this study was to evaluate the “real-world” practice of 18F-Choline PET/CT in patients with prostate cancer and its potential impacts on therapeutic strategy.
This is a retrospective multicenter observational study including 265 consecutive men who underwent 18F-Choline PET/CT for prostate cancer between November 2014 and November 2015. Primary outcome was impact on therapeutic strategy. Secondary outcomes were sensitivity of the 18F-Choline PET/CT and predictive factors associated with positive scans. Statistical analyses comprised Student's t test for continuous variables or chi-squared test for qualitative variables.
Median PSA level at the time of PET/CT was 4.19 ng/ml. The decision to perform PET/CT was made after multidisciplinary discussion in 29.8% of cases; most were prescribed by urologists (50.2% of cases). Three main indications were concerned: biochemical recurrence after local treatment (61.1%), initial staging (26.0%), or at the time of progression to castration-resistance (12.9%). Upon biochemical recurrence, 18F-Choline PET/CT allowed identification of ≥1 site(s) with a sensitivity of 80.9%. In multivariate analysis, predictive factors associated with 18F-Choline PET/CT sensitivity were serum PSA level and local treatment type in cases of biochemical recurrence, and PSA doubling time and Gleason score in case of initial staging. 18F-Choline PET/CT results allowed restaging and change in therapeutic strategy in 58.1% of all combined indications.
Indications of 18F-Choline PET/CT were varied. The detection rate of metastatic lesions was suitable, especially when PSA rate was >1 ng/mL. In most cases, 18F-Choline PET/CT led to a change in therapeutic strategy, particularly in the setting of biochemical recurrence.
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Background: Radical prostatectomy (RP) is recommended as a standard treatment for localized prostate cancer. However no recommendations exist for pts with detectable PSA after RP. ...Methods: Pts with localized prostate cancer, treated by RP (R0 or R1), with a PSA level post-RP ≥ 0.2 ng/mL and ≤ 2 ng/mL at randomization and N0 M0 on imaging were included. Pts were randomized (1:1) to radiotherapy (RT) alone (RT arm) or 6 months degarelix hormone therapy (HT) with RT (RT+HT arm). RT consisted of pelvic irradiation (46 Gy in 23 Fr) with a boost on the prostate bed (66 Gy in 33 Fr). The primary endpoint is the event-free survival (EFS). Secondary endpoints are: 5-yr EFS and metastases-free survival, 5 and 10-yr OS, acute and late toxicity (CTCAE V4.0), and QOL. With 122 patients, the probability of selecting the most effective arm is over 80% for a 20% reduction in the HR = 0.80. Results: From Dec-2012 to Sept-2015, 125 pts were included (RT arm: 64 pts; RT+HT arm: 61). Median follow up is 14.7 months (6.2; 33.5). The baseline characteristics are well-balanced: median age was 66 yrs (50-77), all men having an ECOG ≤ 1 (ECOG 0 in 92%), a median Gleason score of 7 (3-9), a median PSA of 0.3 ng/mL (0.09-1.82) post-RP and 0.6 ng/mL (0.12-3.65) at randomization. All pts received 33 Fr of RT. In the RT+HT arm 98.4% of pts received the 6 months of HT planned. All pts were eligible for safety analysis. No grade 4 toxicity or toxic death was reported. Grade 3 acute toxicity, occurring within 6 months of RT, were reported for 11/125 pts (9%): 3/64 pts (5%) in the RT arm and 8/61 pts (13%) in RT+HT arm (NS). Regarding grade 3 toxicities, the following occurred only in the RT+HT arm: erectile dysfunction (3 pts) and urinary incontinence (2 pts); in contrast, dysuria/pollakiuria (2 pts) occurred only in the RT arm. In the RT+HT arm, grade 2 toxicities included hot flushes (8 pts) and decreased libido (7 pts). Conclusions: In terms of acute toxicities the RT+HT arm is well tolerated with the observed toxicities usually expected with concomitant HT. The primary endpoint analysis is expected for 2018. Clinical trial information: NCT01994239.
The role of
F-fluorocholine positron emission tomography/computed tomography (
F-Choline PET/CT) in different clinical situations remains controversial and current practices are very heterogeneous. ...The aim of this study was to evaluate the "real-world" practice of
F-Choline PET/CT in patients with prostate cancer and its potential impacts on therapeutic strategy.
This is a retrospective multicenter observational study including 265 consecutive men who underwent
F-Choline PET/CT for prostate cancer between November 2014 and November 2015. Primary outcome was impact on therapeutic strategy. Secondary outcomes were sensitivity of the
F-Choline PET/CT and predictive factors associated with positive scans. Statistical analyses comprised Student's t test for continuous variables or chi-squared test for qualitative variables.
Median PSA level at the time of PET/CT was 4.19 ng/ml. The decision to perform PET/CT was made after multidisciplinary discussion in 29.8% of cases; most were prescribed by urologists (50.2% of cases). Three main indications were concerned: biochemical recurrence after local treatment (61.1%), initial staging (26.0%), or at the time of progression to castration-resistance (12.9%). Upon biochemical recurrence,
F-Choline PET/CT allowed identification of ≥1 site(s) with a sensitivity of 80.9%. In multivariate analysis, predictive factors associated with
F-Choline PET/CT sensitivity were serum PSA level and local treatment type in cases of biochemical recurrence, and PSA doubling time and Gleason score in case of initial staging.
F-Choline PET/CT results allowed restaging and change in therapeutic strategy in 58.1% of all combined indications.
Indications of
F-Choline PET/CT were varied. The detection rate of metastatic lesions was suitable, especially when PSA rate was >1 ng/mL. In most cases,
F-Choline PET/CT led to a change in therapeutic strategy, particularly in the setting of biochemical recurrence.
Despite great improvements in the management of metastatic clear cell renal carcinoma, complete responses with antiangiogenic therapies are infrequent and complete pathological responses remain ...anecdotal. We report the complete pathological response of a solitary bone metastasis from a clear cell renal carcinoma after sequential treatment with sunitinib and radiotherapy. In February 2009, a female patient was diagnosed with clear cell renal carcinoma of the left kidney, bearing only one metastatic site localized in the proximal extremity of the left tibia. Radical nephrectomy was performed at first. Thereafter, sunitinib was administered at standard dose level for four weeks followed by two weeks free at each cycle. The patient underwent palliative radiotherapy between the fifth and the sixth cycle. Due to stable status, a radical surgery of the left knee was then performed and pathological analysis concluded a complete response. This case highlights potential synergy between sunitinib and radiation therapy in clear cell renal carcinoma.
