Adjuvant Radiotherapy Improves Outcomes for High-Risk Prostate Cancer

Excerpt:

“Adjuvant radiotherapy appeared associated with better outcomes than surveillance followed by early-salvage radiotherapy among patients with prostate cancer with adverse pathological features who underwent prostatectomy, according to study results published in JAMA Oncology.

” ‘It remains very controversial whether patients with high-risk features after a radical prostatectomy for prostate cancer should receive adjuvant radiation therapy to prevent a recurrence of their prostate cancer as measured by a rise in PSA, or whether we should observe patients after surgery and only radiate those who demonstrate a detectable PSA,’ Rahul D. Tendulkar, MD, of the department of radiation oncology at Cleveland Clinic, told HemOnc Today.”

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Risk Tool IDs Candidates for Adjuvant RT in Prostate Cancer

Excerpt:

“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.”

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Continued Preventive Effect of Radiotherapy After Breast-Conserving Surgery for DCIS in 20-Year Follow-Up of SweDCIS Trial

The gist: Radiotherapy after breast-conserving surgery to remove the tumor may give long-term benefits to women with ductal carcinoma in situ (DCIS). In a clinical trial, researchers followed the patients for 20 years after their treatment. Patients who had gotten radiotherapy after surgery were less likely to have their cancer come back later in the same breast.

“The 20-year follow-up of the Swedish randomized SweDCIS trial, reported by Wärnberg et al in the Journal of Clinical Oncology, shows a continued benefit of radiotherapy after breast-conserving surgery for ductal carcinoma in situ (DCIS) in preventing ipsilateral disease. A nonsignificant increase in contralateral breast disease was observed in the radiotherapy group…

“The investigators concluded: ‘Use of adjuvant radiotherapy is supported by 20-year follow-up. Modest protection against invasive recurrences and a possible increase in contralateral cancers still call for a need to find groups of patients for whom radiotherapy could be avoided or mastectomy with breast reconstruction is indicated.’ “


ASCO Endorses AUA/ASTRO Guideline on Adjuvant and Salvage Radiotherapy After Prostatectomy

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.”


Patients Who Have Left Breast Tumors Have Comparable OS to Those with Right Breast Tumors

“Tumor laterality (left-side vs. right-side) does not impact overall survival in breast cancer patients treated with breast-conserving surgery and adjuvant external beam radiation therapy, according to a study published in the October 1, 2014 issue of the International Journal of Radiation Oncology • Biology • Physics (Red Journal), the official scientific journal of the American Society for Radiation Oncology (ASTRO).

“Studies have shown that breast cancer patients treated with radiation therapy have improved local-regional recurrence, and breast cancer-specific survival after breast-conserving surgery and overall survival (OS) after mastectomy. Long-term follow-up of historic radiation therapy trials for breast cancer has demonstrated a potential increase in cardiac mortality. However, these studies used earlier modes of radiation therapy including Cobalt and orthovoltage radiotherapy, and did not employ CT-based planning, which allows for greater cardiac avoidance. Three recent studies suggest that cardiac mortality has not been greater for patients treated for left-sided breast cancer since the 1980s, when techniques allowing for greater cardiac avoidance became more commonplace[1-3].

“This study, ‘Breast Cancer Laterality Does Not Influence Survival in a Large Modern Cohort: Implications for Radiation-Related Cardiac Mortality,’ examines the impact of tumor laterality on overall survival in a modern cohort of patients from the National Cancer Database (NCDB). The NCDB, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, contains deidentified data from approximately 70 percent of newly diagnosed cancers in the United States. The NCBD is more than two times larger than the Surveillance, Epidemiology and End Results (SEER) database, and the NCBD contains data not found in SEER, including histopathologic data and specific treatment information such as sequencing of therapies, dose, technique (e.g., intensity modulated radiation therapy vs. brachytherapy) and target (e.g., breast only vs. breast and regional nodes).”


Genomic Analysis of Prostate Cancer Indicates Best Course of Action After Surgery

“There is controversy over how best to treat patients after they’ve undergone surgery for prostate cancer. Does one wait until the cancer comes back or provide men with additional radiation therapy to prevent cancer recurrence? Now, a new study from Thomas Jefferson University shows that a genomic tool can help doctors and patients make a more informed decision.

” ‘We are moving away from treating everyone the same,’ says first author Robert Den, M.D., Assistant Professor of Radiation Oncology and Cancer Biology at Thomas Jefferson University. ‘Genomic tools are letting us gauge which cancers are more aggressive and should be treated earlier with radiation, and which ones are unlikely to benefit from additional therapy.’

“Although surgery for prostate cancer is meant to be curative, in some men, the cancer can regrow. Doctors have developed high risk criteria based on clinical factors, but these criteria are imperfect predictors of cancer returning, or recurrence. Only about 50 percent of high risk patients ever go on to develop metastases, raising the question of whether those who receive additional therapy are being overtreated.

“In an attempt to better understand how to treat their patient population, researchers led by Drs. Den and Adam Dicker, M.D., Ph.D., Chairman of the Department of Radiation Oncology at Jefferson, together with other members of the Kimmel Cancer Center Genitourinary team including Dr. Leonard Gomella, Chairman of the Department of Urology, assessed whether a genomic test designed to predict prostate cancer metastasis could also predict which patients would most benefit from radiation treatment after surgery.

“The test, called Decipher, from the genome diagnostics company GenomeDx, generates a gene signature from a patient’s cancer tissue sample. Based on this signature, the test stratifies patients into high, intermediate and low risk for cancer recurrence and metastases.”


IMRT Benefits in Prostate Cancer Questioned

Men with prostate cancer gained no obvious benefits from treatment with the dominant form of adjuvant radiation therapy as compared with an older, less expensive technique, an analysis of a government database suggests.”


Groups Back Adjuvant RT for Some Prostate Cancers

“Men with adverse-pathology prostate cancer should have the option of adjuvant radiation therapy after prostatectomy, according to a clinical guideline issued jointly by two organizations…”


10-Year Follow Up Study Shows Adjuvant Radiotherapy Is Safe After Prostatectomy

The use of adjuvant radiotherapy in patients with pT3 prostate cancer subsequent to radical prostatectomy is safe, according to 10-year follow-up results presented at the American Society of Clinical Oncology (ASCO) 2013 Genitourinary Cancers Symposium. Those patients in the trial who were treated with adjuvant radiotherapy had a 21% absolute increase in biochemical non-evidence of disease compared with patients who were assigned to wait-and-see treatment after surgery, adding to previous evidence of the safety of radiotherapy in the long-term.