Re-irradiation of prostate cancer local failures after previous curative radiotherapy: long-term outcome and tolerance

Publication date: Available online 28 May 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Thomas Zilli, Eileen Benz, Giovanna Dipasquale, Michel Rouzaud, Raymond Miralbell
Purpose/ObjectiveTo evaluate safety, feasibility, side-effect profile, and proof of concept of external beam radiotherapy (EBRT) with or without a brachytherapy (BT) boost for salvage of exclusive local failure after primary EBRT for prostate cancer.Materials and MethodsFourteen patients with presumed exclusive local recurrence after primary EBRT with or without BT were considered eligible for re-irradiation. The median normalized total dose in 2 Gy-fractions (NTD2Gy, α/β ratio=1.5 Gy) was 74 Gy (66-98.4) at 1^st irradiation. Median time between the 1^st RT and the re-irradiation was 6.1 years (range, 4.7-10.2).ResultsBetween 2003 and 2008 salvage treatment was delivered with a median NTD2Gy of 85.1 Gy (70-93.4) to the prostate with EBRT with (n=10) or without (n=4) BT. Androgen deprivation was given to 12 patients (median time of 12 months). No Grade ≥ 3 toxicity was observed during and within 6 weeks after RT. After a median follow-up of 94 months (range, 48-172) post-salvage RT, 5-year Grade ≥3 GU and GI toxicity-free survival figures were 77.9±11.3% and 57.1±13.2%, respectively. Four patients presented with combined Grade 4 GU/GI toxicity. The 5-year biochemical relapse-free, local relapse-free, distant metastasis-free and cancer-specific survivals were 35.7±12.8%, 50.0±13.4%, 85.7±9.4%, and 100%, respectively.ConclusionSalvage whole gland re-irradiation for patients with a suspicious of exclusive local recurrence after initial RT may be associated with a high rate of severe radiation-induced side-effects and a poor long-term biochemical and local control.

Teaser

In this retrospective study we evaluated the long-term results of fourteen prostate cancer patients treated with salvage external beam radiotherapy (EBRT) for exclusive local failure after primary EBRT. Whole gland re-irradiation resulted in a high rate of severe radiation-induced side-effects and a poor long-term biochemical and local control. Alternative salvage re-irradiation modalities should be explored for selected cases of local relapse in accurately designed prospective trials.


from Cancer via ola Kala on Inoreader http://ift.tt/25tPpSj
via IFTTT

Prognostic value of p16 status on the development of a complete response in involved oropharynx cancer neck nodes after cisplatin based chemoradiation – a secondary analysis of NRG Oncology RTOG 0129

Publication date: Available online 28 May 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Thomas J. Galloway, Qiang (Ed) Zhang, Phuc Felix Nguyen-Tan, David I. Rosenthal, Denis Soulieres, André Fortin, Craig L. Silverman, Megan E. Daly, John A. Ridge, J Alexander Hammond, Quynh-Thu Le
PurposeTo determine the relationship between p16 status and the regional response of patients with node positive oropharynx cancer treated on Study XXXX.Materials and MethodsPatients with N1-N3 oropharynx cancer and known p16 status who underwent treatment on Study XXXX were analyzed. Pathologic complete response rates in patients treated with a post-chemoradiation neck dissection (with p16-positive or p16-negative cancer) were compared by Fisher's exact test. Patients managed expectantly were compared to those treated with a neck dissection.ResultsNinety-nine of 292 (34%) of patients with node positive oropharynx cancer and known p16 status underwent a post-treatment neck dissection (p16-positive: n=69 and p16-negative: n=30). The remaining 193 patients with malignant lymphadenopathy at diagnosis were observed. Neck dissection was performed a median of 70 (range 17 - 169) days after completion of chemoradiation. Neither the pre-treatment nodal stage (p=0.71) nor the post-radiation, pre-neck dissection clinical/radiographic neck assessment (p=0.42) differed by p16 status.A pathologic complete response (pCR) was more common among p16-positive patients (78%) than p16-negative patients (53%, p=0.02) and was associated with a reduced incidence of local-regional failure (HR 0.33, p = 0.003). On multivariate analysis (MVA) of local-regional failure a test for interaction between pCR and p16 status was not significant (p = 0.37).One-hundred-ninety-three of 292 (66%) of initially node positive patients were managed without a post-treatment neck dissection. Development of a clinical CR was not significantly influenced by p16-status (p = 0.42). Observed patients with a clinical nodal CR had disease control outcomes similar to patients with a pCR neck dissection.ConclusionsPatients with p16-positive tumors had significantly higher complete pathologic response and locoregional control rates than those with p16-negative tumors.

Teaser

This second analysis of XXXX investigates the role of post-treatment neck dissection in the management of node positive oropharynx cancer managed with primary chemoradiation. Patients treated on protocol were imaged 6-8 weeks after the completion of chemoradiation and post-treatment neck dissection was recommended for those with advanced stage (N2-N3) at diagnosis. p16-positive tumors are significantly more likely to develop a complete pathologic response. Many patients were ultimately observed, without increased regional failure.


from Cancer via ola Kala on Inoreader http://ift.tt/1UcJ3eq
via IFTTT