During the first year of the COVID-19 pandemic there was a global disruption in the provision of healthcare. Grade 4 gliomas are rapidly progressive tumors, and these patients are at risk of poorer outcomes due to delays in diagnosis or treatment. We retrospectively evaluated the impact of the pandemic on treatment patterns and outcomes of patients with grade 4 gliomas in British Columbia. We identified a cohort of 85 patients treated with radiotherapy between March 2020–2021 (COVID era) and compared baseline characteristics, treatments, and outcomes with a control cohort of 79 patients treated between March 2018–2019 (pre-COVID era). There were fewer patients treated with radiotherapy over age 65 in the COVID era compared to the pre-COVID era (p = 0.037). Significantly more patients were managed with biopsy relative to partial or gross total resection during the COVID era compared to the pre-COVID era (p = 0.04), but there were no other significant differences in time to assessment, time to treatment, or administration of adjuvant therapy. There was no difference in overall survival between eras (p = 0.189). In this assessment of outcomes of grade 4 gliomas during the pandemic, we found that despite less aggressive surgical intervention during the COVID era, outcomes were similar between eras.

Purpose/Objective(s): Biochemical recurrence (BCR) following radiotherapy for prostate cancer is accepted as treatment failure and is used to guide clinical management. PSA nadir + 2 ng/mL (Phoenix definition) is the formula most commonly used to establish BCR, however, not all patients that meet the definition progress to clinical recurrence. The purpose of this study is to analyze the performance of the Phoenix definition in a cohort of patients with intermediate-risk prostate cancer, treated with external beam radiotherapy (EBRT) with or without hormones. Materials/Methods: We conducted a retrospective review of all intermediate risk prostate cancer patients treated curatively at our cancer center, which is the sole provider of radiotherapy within our provincial local health region, serving 1.3 million people. Patient demographics, cancer, treatment, and subsequent clinical course details were obtained from the electronic medical record. Descriptive statistics, Kaplan-Meier (KM) survival estimates, and Cox proportional hazards were used to analyze risk factors for clinical recurrence in patients with BCR. Results: Between 2002 and 2007, 542 men were treated with EBRT to a median dose of 76 Gy (70 Gy-85 Gy). Median age was 70 years (40-83 years), median PSA was 9 ng/mL (1.3 e 20 ng/mL). Seventy-three percent of patients had Gleason 7, 54.3% had stage T1 and 45.7% stage T2. Median follow up for all patients was 9 years (3 months-16 years). Ninety-three patients (17.15%) had BCR (median follow up of 10.5 years, range 2e 16 years). Demographics and median PSA for these patients were similar to those in the main cohort. Eighty-five percent had Gleason 7, 48% had stage T1, and 52% had T2 disease. Treatment at BCR included: hormonal treatment for 74%, local treatment for 7.5%, while 18.5% were observed. Median time to BCR was 4.4 years (7 months e 14.3 years) for an actuarial probability of having BCR of 24.9% at 10 years. PSA at diagnosis (HR Z 1.4, p Z 0.02) and Gleason 7 (HR Z 2.07, p Z 0.01), were statistically significant risk factors for BCR, while age and stage were not. Forty-nine (52.7%) patients with BCR developed clinical recurrence at a median of 13.5 months (0 e 132 months), for an actuarial probability of clinical recurrence of 40% at 5 years and 71% at 10 years. One patient developed clinical recurrence without having BCR (local recurrence, small cell differentiation with undetectable PSA). There were no statistically significant risk factors for clinical recurrence identified. Patients with stage T2 (HR Z 1.7, p Z 0.07) and with first PSA at time of BCR >5 showed trends towards increased clinical recurrence risk (HR Z 1.7, p Z 0.08). Conclusion: In a large cohort of intermediate risk prostate cancer patients, treated with high dose radiation with or without hormones, the risk of biochemical recurrence is modest at 10 years. Of those patients who fail, 70% have developed clinical recurrence ten years after biochemical recurrence. The Phoenix definition of BCR does a reasonable job of predicting long te...

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Biochemical recurrence following prostate cancer radiotherapy is the accepted barometer of treatment failure and is used to guide clinical management in a given patient as well as to compare the relative efficacy of different treatments. As normal prostatic acini recover from radiotherapy, they secrete PSA even though all the cancer in the prostate may have been eradicated. Knowledge about when such PSA increases that meet the definition of biochemical failure but does not indicate cancer recurrence is important. To determine this rate we studied our mature institutional experience treating intermediate risk prostate cancer with external beam radiotherapy (EBRT). Materials/Methods: Our center serves a population of 1.3 million persons and is the sole provider of radiotherapy within our provincial local health region. A retrospective review of our experience with intermediate risk prostate cancer (PSA 10-20 and/or Gleason score 7 and/or T stage< T3) treated for cure with EBRT (with or without adjuvant hormones) and a minimum of 10 years since completion of the radiation was performed. Patient demographic, cancer, treatment, and subsequent clinical course details were abstracted from the electronic medical record. Biochemical failure status as per the Phoenix definition was determined. Among the patients with biochemical failure, clinical cancer recurrence was defined as the occurrence of any of the following:1) PSA >5, 2) initiation of hormonal treatment, 3) utilization of any salvage loco regional treatment, 4) clinical/imaging determination of local, regional or metastatic recurrence 5) unknown status. Results: Between 2002 and 2007 542 men were treated by a 3D CRT or IMRT EBRT technique to a median dose of 76 Gy in 38 fractions. Age ranged from 40 to 83 years (median 70) Median follow up was 76 months (range 3 to 191), 82.9% (449 patients) remain in remission, and 17.1% (93 patients) have developed biochemical failure. Among the patients with biochemical failure 15% (14 patients) have had no clinical cancer recurrence for a calculated actuarial probability of patients with biochemical failure actually NOT having clinical cancer of 19% at 5 years. Serum testosterone levels are available in 11 of these 14 patients. 9/11 had normal testosterone and 2/11 are hypogonadal. Conclusion: An appreciable proportion of patients with biochemical failure following EBRT for intermediate risk prostate cancer do not have clinical cancer recurrence. This 19% (an underestimate as a proportion of patients who had hormones initiated as soon as biochemical failure was diagnosed likely did not have cancer) presumably reflects recuperating benign prostatic epithelium and should be considered both when comparing the treatment efficacy of EBRT with other modalities and when contemplating initiation of hormones or local salvage treatments.