301 Background: The aim is to investigate the clinical significance of biochemical response after Androgen Deprivation Therapy (ADT) prior to high-dose-rate brachytherapy (HDR-BT) for early identification of patients at increased risk of recurrence. Measured outcomes included biochemical relapse free survival (bRFS), distant metastasis free survival (DMFS) and overall survival (OS). Methods: A total of 324 patients with high-risk Prostate Cancer (PCa) were identified in the Norwegian Radium Hospital brachytherapy database. Neo-adjuvant ADT was administered for 3-6 months, followed by two 10 Gy HDR-BT treatments to the prostate, each spaced by two weeks, followed by conformal external beam radiation to 50 Gy to the prostate gland and seminal vesicles. Total length of ADT ranged from 12 to 36 months. PSA (ng/mL) and testosterone values (T, nmol/L) after 3-6 months of neo-adjuvant ADT were measured. Kaplan Meier and Cox regression analyses were performed. Results: Median age at diagnosis was 66 years and median follow-up was 10 years. At last follow-up, 277 patients (85,2%) were alive, 10 patients (3.1%) had died of prostate cancer and 37 patients (11.4%) died of other causes. 24 patients (7.4%) had biochemical relapse and 9 patients (2.8%) had distant metastasis within the first 5 years. Patients with PSA > 1 after neo-adjuvant therapy had 4.3 (95%CI 1.7 to 11.1) higher odds of biochemical relapse within 5 years compared to patients with PSA < 1 (p = 0.002). ROC analysis confirmed that PSA < 1 had a prediction accuracy of 0.76 (sensitivity 68% and specificity 67%). T < 0.7 and PSA < 1 after neo-adjuvant therapy were associated with improved bRFS, DMFS and OS (p < 0.001). Neither the length of neo-adjuvant nor total ADT treatment impacted outcomes (p > 0.05). Conclusions: Dose intensification with 2 HDR-BT boosts resulted in excellent survival in our cohort. PSA > 1 after neo-adjuvant ADT may be able to predict patients at increased risk of relapse and worse OS and identify patients in whom increased monitoring and/or intervention is warranted. ADT > 1 year did not improve outcome, indicating that shorter course of ADT may be used.

No abstract

The treatment of brain tumors has evolved over the past few decades. While whole brain radiation therapy was the standard of care in the management of tumors for years, stereotactic radiation has for the most part replaced the technique in the management of metastatic tumors of the brain. In this review, the current indications are reviewed for both whole brain and stereotactic radiation therapy in the management of metastatic cancers involving the central nervous system, the most common types of malignancies diagnosed in the brain.

The number of effective systemic drug options for metastatic melanoma has expanded rapidly in recent years. Immunotherapies with anti-CTLA4 or anti-PD1 inhibitors and targeted therapy with BRAF and MEK inhibitors have improved the response rates and overall survival (OS) compared with chemotherapy. With such radical changes, contemporary data on the outcome, safety, and prognostication of patients who received SRS in management of MBM is needed. Materials/Methods: Retrospective review of 125 consecutive patients who received SRS to 419 MBM from August 2010 to 2015. Ninety-four patients also received systemic treatment within 6 weeks of SRS. Endpoints included brain control (BC), defined as absence of any active intracranial disease on clinical and radiological evaluation at last follow-up/death and OS. Univariate and multivariate analysis was performed on clinic-pathological prognostic features associated with OS and BC. Results: The median age of the cohort was 58.7 years, and 70% were males. The median follow-up was 7.8 months. Fourteen percent did not have extracranial disease at the time of the diagnosis of MBM, and 42% had a single, 34% had 2-3, 20% had 4-10, and 4% had >10 MBM. Fortyfive percent had B-RAF mutant disease. Whole-brain radiation therapy was used in addition to SRS in 42%, and 75% had systemic therapy (30% anti-CTLA4 inhibitor, 25% anti-PD1 inhibitor, 54% targeted therapy, 17% chemotherapy). Median OS and BC were 11.8 months and 10.0 months, respectively. OS and BC rates were 49.5% and 44.2%, respectively, at 1 year and 30.1% and 19.2%, respectively, at 2 years. In 2 patients with histologically confirmed radionecrosis after SRS, 1 had combination anti-CTLA4 and anti-PD1 therapy while the other had no systemic treatment. B-RAF mutation status, ECOG performance status (PS), graded prognostic assessment (GPA) score, disease-specific GPA score, and number and volume of MBM were associated with improved OS and BC on univariate analysis. On multivariate analysis, ECOG PS, number of MBM, B-RAF mutant status, and the use of immunotherapy were associated with improved OS and the same variables except for the use of immunotherapy were also significant for BC. Conclusion:In the era of effective systemic treatment in melanoma, SRS remains a safe and important brain-directed therapy for MBM with good OS and BC observed in appropriately selected patients. Further studies are required to identify the timing for SRS and sequencing with systemic therapy in this rapidly evolving area.