“A novel risk stratification tool that combines pathologic tumor characteristics with data from the Decipher genomic classifier may help predict 5- and 10-year metastasis-free survival in patients with aggressive prostate cancer after radical prostatectomy with an accuracy of 85%, researchers reported.
“It can also be used to identify patients with prostate cancer who could benefit from postoperative adjuvant radiotherapy (aRT), thereby reducing risk of overtreatment, adverse effects, and clinical recurrence (CR), Firas Abdollah, MD, of Vattikuti Urology Institute at the Henry Ford Health System in Detroit, and colleagues reported online in the Journal of Clinical Oncology.”
“A prospective study of guideline-based, postoperative, image-guided intensity-modulated radiation therapy in patients with prostate cancer found low toxicity profiles and favorable patient-reported quality of life following treatment, with researchers concluding that toxicity and health-related quality of life should not impact the recommendation of radiation therapy following prostatectomy. The research was published by Berlin et al in Practical Radiation Oncology.
“Postprostatectomy radiation therapy has been reported as underutilized, with randomized trials showing the benefit of adjuvant radiation therapy, but only about 10% of patients receiving the treatment. One potential reason for underutilization could be concern over side effects or a negative impact on health-related quality of life.”
The gist: In August, a new guideline from leading prostate cancer expert groups recommended that doctors discuss post-surgery radiation treatment with some prostate cancer patients. Now, the American Society of Clinical Oncology (ASCO) has officially endorsed the guideline. If a doctor finds certain tumor characteristics during prostatectomy (cancer cells invading the seminal vesicle, or extensive tumor invasion in the area surrounding the tumor), they should discuss adjuvant radiation to keep the cancer from returning. If the patient has detectable PSA levels after prostatectomy, or if the cancer returns in the same place, they should know about salvage radiation.
“The American Society of Clinical Oncology (ASCO) today issued an endorsement of the American Urological Association (AUA)/American Society for Radiation Oncology (ASTRO) guideline on the use of adjuvant and salvage radiotherapy after prostatectomy, which was based on a systematic review of medical literature. The ASCO endorsement was published today in the Journal of Clinical Oncology.
“The AUA/ASTRO guideline recommends that physicians discuss adjuvant radiotherapy with patients who have adverse pathologic findings at prostatectomy (ie, seminal vesicle invasion, extensive positive surgical margins) and salvage radiotherapy with patients with detectable postoperative prostate-specific antigen (PSA) or local recurrence after prostatectomy. Patients should be informed that, while adjuvant radiotherapy reduces the risk of recurrence and disease progression, its impact on preventing metastases and extending survival is less clear.”
Editor’s note: Researchers conducted a clinical trial with volunteer patients to test whether giving radiation after tumor-removal surgery could stave off recurrence for people with diffuse-type gastric cancer. A treatment that follows an initial treatment to reduce the risk of the cancer returning is known as an “adjuvant therapy.” In this clinical trial, patients who received adjuvant radiation therapy after surgery survived significantly longer than patients who did not.
“Patients with diffuse-type gastric cancer demonstrated prolonged OS when they received adjuvant radiation therapy, according to results of a SEER analysis.
“Alexander M. Stessin, MD, PhD, of the department of radiation oncology at Weill Cornell Medical College, and colleagues used the 2002 to 2005 SEER database to identify 1,889 patients with newly diagnosed diffuse-type gastric cancer who underwent surgical resection. Of these patients, 782 received adjuvant radiation therapy and 1,107 did not.
“Patients who received adjuvant radiation therapy were younger, more likely to have ≥15 dissected lymph nodes and more likely to have N3 lymph node status. They also had a higher American Joint Committee on Cancer disease stage.”