Adjuvant or salvage radiotherapy for the treatment of localised prostate cancer? A prospectively planned aggregate data meta-analysis

Vale, Claire; Brihoum, Meryem; Chabaud, Sylvie; Cook, Adrian; Fisher, David J.; Forcat, Silvia; Fraser-Browne, Carol; Herschtal, Alan; Kneebone, Andrew; Nénan, Soazig; Parker, Chris; Parmar, Mahesh; Pearse, Maria; Richaud, Pierre; Rogozińska, Ewelina; Sargos, P.; Sydes, M; Tierney, Jayne

doi:10.1093/annonc/mdz394.041

Cited by 39 publications

(32 citation statements)

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“…Such selection is paramount, especially when considering the results of Phase 3 studies comparing early salvage radiotherapy and adjuvant radiotherapy. Preliminary results from RADICALS-RT, GETUG-AFU 17, RAVES, and their meta-analysis (ARTISTIC) [8][9][10] suggested that eSRT was not significantly different from aRT, thereby favoring the use of eSRT instead of aRT.…”

Section: Discussionmentioning

confidence: 99%

“…Adjuvant radiotherapy (aRT) improves BCR-free survival, but its impact on overall survival is controversial and was shown to increase gastrointestinal and genitourinary side effects [4][5][6][7]. Hence, aRT was recently challenged by early salvage radiotherapy (esRT) with no significant benefit emerging for the use of aRT for BCR-free survival, thus highlighting the need for additional biomarkers to enable patient selection [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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External Validation of an MRI-Derived Radiomics Model to Predict Biochemical Recurrence after Surgery for High-Risk Prostate Cancer

Bourbonne

Fournier

Vallières

et al. 2020

Cancers

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Adjuvant radiotherapy after prostatectomy was recently challenged by early salvage radiotherapy, which highlighted the need for biomarkers to improve risk stratification. Therefore, we developed an MRI ADC map-derived radiomics model to predict biochemical recurrence (BCR) and BCR-free survival (bRFS) after surgery. Our goal in this work was to externally validate this radiomics-based prediction model. Experimental Design: A total of 195 patients with a high recurrence risk of prostate cancer (pT3-4 and/or R1 and/or Gleason’s score > 7) were retrospectively included in two institutions. Patients with postoperative PSA (Prostate Specific Antigen) > 0.04 ng/mL or lymph node involvement were excluded. Radiomics features were extracted from T2 and ADC delineated tumors. A total of 107 patients from Institution 1 were used to retrain the previously published model. The retrained model was then applied to 88 patients from Institution 2 for external validation. BCR predictions were evaluated using AUC (Area Under the Curve), accuracy, and bRFS using Kaplan–Meier curves. Results: With a median follow-up of 46.3 months, 52/195 patients experienced BCR. In the retraining cohort, the clinical prediction model (combining the number of risk factors and postoperative PSA) demonstrated moderate predictive power (accuracy of 63%). The radiomics model (ADC-based SZEGLSZM) predicted BCR with an accuracy of 78% and allowed for significant stratification of patients for bRFS (p < 0.0001). In Institution 2, this radiomics model remained predictive of BCR (accuracy of 0.76%) contrary to the clinical model (accuracy of 0.56%). Conclusions: The recently developed MRI ADC map-based radiomics model was validated in terms of its predictive accuracy of BCR and bRFS after prostatectomy in an external cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

External Validation of an MRI-Derived Radiomics Model to Predict Biochemical Recurrence after Surgery for High-Risk Prostate Cancer

Bourbonne

Fournier

Vallières

et al. 2020

Cancers

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“…Immintely reporting phase III clinical trials will address some of the uncertainties facing the management of the post-prostatectomy patients. The presented RAVES and RADICALS trials as well as the ARTISTIC meta-analysis suggest that salvage radiotherapy is of similar benefit to adjuvant radiotherapy, limiting the number of patients we may consider for adjuvant radiotherapy among patients with high-risk features for recurrence (30)(31)(32). GETUG-AFU 17 investigates a broader spectrum of patients at a greater risk for recurrence and compares adjuvant vs. early salvage radiotherapy, both combined with concurrent ST-ADT (20).…”

Section: Discussionmentioning

confidence: 99%

Combined Long-Term Androgen Deprivation and Pelvic Radiotherapy in the Post-operative Management of Pathologically Defined High-Risk Prostate Cancer Patients: Results of the Prospective Phase II McGill 0913 Study

et al. 2020

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Following radical prostatectomy, prostate bed radiotherapy (PBRT) has been combined with either long-term androgen deprivation therapy (LT-ADT) or short-term ADT with pelvic lymph node radiotherapy (PLNRT) to provide an oncological benefit in randomized trials. McGill 0913 was designed to characterize the efficacy of combining PBRT, PLNRT, and LT-ADT. It is the first study to do so prospectively. Methods: In a single arm phase II trial conduced from 2010 to 2016, 46 post-prostatectomy prostate cancer patients at a high-risk for relapse (pathological Gleason 8+ or T3) were assessed for treatment with combined LT-ADT (24 months), PBRT, and PLNRT. Patients received PLNRT and PBRT (44 Gy in 22 fractions) followed by a PBRT boost (22 Gy in 11 fractions). The primary endpoint was progression-free survival (PFS). Toxicity and quality of life (QoL) were evaluated using CTCAE V3.0 and EQ-5D-3L questionnaires, respectively. Results: Among the 43 patients were treated as per protocol, median PSA was 0.30 µg/L. On surgical pathology, 51% had positive margins, 40% had Gleason 8+ disease, 42% had seminal vesicle involvement, and 19% had lymph node involvement. At a median follow-up of 5.2 years, there were no deaths or clinical progression. At 5 years, PFS was 78.0% (95% Confidence Interval 63.7-95.5%). Not including erectile dysfunction, patients experienced: 14% grade 2 endocrine toxicity while on ADT, one incident of long-term gynecomastia, 5% grade 2 acute urinary toxicity, 5% grade 2 late Kucharczyk et al. McGill 0913: Pelvic Radiotherapy and LT-ADT Urinary toxicity, and 24% long-term hypogonadism. No comparison between the average or minimum self-reported QoL at baseline, during ADT, nor after ADT demonstrated a statistically significant difference. Conclusions: Combining PBRT, PLNRT, and LT-ADT had an acceptable PFS in patients with significant post-operative risk factors for recurrence. While therapy was well-tolerated, long-term hypogonadism was a substantial risk. Further investigations are needed to determine if this combination is beneficial. Trial registration: NCT01255891.

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“…II. In men with high risk features post RP, early salvage RT is recommended over up front adjuvant RT 26,27 . Men with BCR and no evidence of metastases should have ongoing PSA and imaging assessments as indicated, and the frequency should be dictated by disease risk and PSA doubling time.…”

Section: Advanced Prostate Cancer (Clinical Nodal Involvement Biochementioning

confidence: 99%

A Canadian framework for managing prostate cancer during the COVID-19 pandemic: Recommendations from the Canadian Urologic Oncology Group and the Canadian Urological Association

Kokorovic

Hotte

et al. 2020

CUAJ

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triaging and the use of systemic therapies in genitourinary malignancies 7,9 . The purpose of this publication is to provide a multidisciplinary framework focused on prostate cancer management in the setting of the COVID-19 global pandemic within the Canadian context. General principles1. This consensus statement is a guide to help physicians manage prostate cancer during the acute phase of a pandemic. Treatment prioritization must take into account regional differences in infection rates, resource capacity and mitigation efforts. The current pandemic has had a widespread reach across all Canadian communities, but we recognize that the degree of impact varies, and that provincial and institutional policies are not uniform. Physicians must continue to monitor a continuously evolving situation and make adjustments to clinical decisions as deemed appropriate. The risk of serious morbidity resulting from SARS-CoV-2 infection may outweigh thecompeting risk of prostate cancer in many men. Observation of prostate cancer in carefully selected patients does not increase long-term mortality 10,11 , and therefore shortterm treatment delays are unlikely to lead to disease progression and worse outcomes . All management decisions should be based on this core principle. Appropriate patient counseling and shared decision making is strongly encouraged.Men diagnosed with prostate cancer have increased anxiety and psychological distress 12,13 . This will undeniably become amplified in the setting of a global health crisis. Despite resource restrictions and changes in treatment recommendations, physicians must continue to address the needs of patients and involve them in the decision-making process. This approach may decrease patient anxiety levels and improve outcomes once regular practice resumes. Prioritization must be given to limiting exposures of patients and healthcare workers toSARS-CoV-2. Implementation of telehealth visits significantly reduces the risk of infection among frontline personnel and patients, but also preserves critically needed hospital resources. For these reasons, telehealth visits are strongly encouraged. In-person consultations should be limited to men with new symptoms, those requiring a physical examination and for the evaluation and management of treatment-related serious adverse events. In men who require an in-person assessment, consideration should be given to not repeating visits when two specialists are consulted, nor when pre-operative assessment is needed. The healthcare provider should coordinate their needs to minimize patient's visits. CUAJ -Consensus Statement Kokorovic et al Managing prostate cancer during COVID-193

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Adjuvant or salvage radiotherapy for the treatment of localised prostate cancer? A prospectively planned aggregate data meta-analysis

Cited by 39 publications

References 0 publications

External Validation of an MRI-Derived Radiomics Model to Predict Biochemical Recurrence after Surgery for High-Risk Prostate Cancer

External Validation of an MRI-Derived Radiomics Model to Predict Biochemical Recurrence after Surgery for High-Risk Prostate Cancer

Combined Long-Term Androgen Deprivation and Pelvic Radiotherapy in the Post-operative Management of Pathologically Defined High-Risk Prostate Cancer Patients: Results of the Prospective Phase II McGill 0913 Study

A Canadian framework for managing prostate cancer during the COVID-19 pandemic: Recommendations from the Canadian Urologic Oncology Group and the Canadian Urological Association

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