Higher Volume Radiation Facilities Associated With Better Survival Rates for Men with High Risk Prostate Cancer

Excerpt:

“In a new study led by researchers at Brigham and Women’s Hospital, investigators looked at men with aggressive prostate cancer who were treated with radiation as well as the case volume of the facility at which they were treated.  They found that receiving radiation at a facility that treats a high volume of prostate cancer patients with radiation was associated with improved overall survival.

“These findings are published online and appear in the March 15, 2016 issue of the International Journal of Radiation Oncology, Biology, and Physics...”

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Androgen Suppression Plus RT Improves DFS in Prostate Ca

“Adding 6 months of androgen suppression (AS) to radiation therapy improved biochemical disease-free survival in high-risk localized prostate cancer patients – even at radiation doses of 78 Gy – and it did so with acceptable adverse effects, according to a randomized European Organisation for Research and Treatment of Cancer trial reported in the Journal of Clinical Oncology.

“At 7.2 years’ median follow-up, the study found that combination therapy led to a 5-year biochemical disease-free survival of 82.6% (95% CI 78.4-86.1) versus 69.8% for radiation alone (95% CI 64.9-74.2) – translating to a hazard ratio of 0.52 (95% CI 0.41-0.66, P=0.001, 319 events). Adjuvant AS also improved clinical progression-free survival, for an HR of 0.63 (95% CI 0.48-0.84, P=0.001, 205 events).

“No statistically significant interaction between treatment effect and radiation dose emerged: heterogeneity P=0.79 and P=0.66, for biochemical disease-free survival and progression-free survival, respectively, according to Michel Bolla, MD, of Grenoble University Hospital in France, and colleagues.”


Surgery Improves Survival Rates for Men With Prostate Cancer If Radiation Treatments Fail

“Approximately 14 percent of men will be diagnosed with prostate cancer at some point in their lifetimes, according to the National Institutes of Health. Radiation therapy traditionally has been a primary treatment for the cancer, but one-fourth of men have a recurrence of prostate cancer within five years after the therapy. Now, a University of Missouri School of Medicine researcher has found that a complex procedure to remove the prostate achieves excellent long-term survival for men after radiation therapy has failed.

” ‘Prostate cancer, unfortunately, is a common cancer, and more than 27,000 men are estimated to have died from the disease in 2015,’ said Naveen Pokala, M.D., an assistant professor in the Division of Urology at the MU School of Medicine and lead author of the study. ‘By studying a national database of prostate cancer cases, we found that a procedure known as salvage radical prostatectomy can greatly increase a man’s chance of survival when traditional radiation therapy has failed to eradicate the cancer.’ ”


Hypofractionation Is Ready for Prime Time in Prostate Cancer, but Will It Be Adopted?

“Separate phase III trials presented at the 2016 Genitourinary Cancers Symposium demonstrated that modest hypofractionated radiotherapy is noninferior to conventional radiotherapy for men with intermediate- and low-risk prostate cancer and should be considered a new standard of care.1,2 However, it is not clear how widely adopted hypofractionation schedules will be.

“NRG Oncology RTOG 0415 was a randomized, phase III, noninferiority study comparing two fractionation schedules in men with low-risk prostate cancer: conventional radiotherapy (73 Gy in 41 fractions over 8.3 weeks) vs hypofractionation (70 Gy in 28 fractions over 5.6 weeks).1

“The study enrolled 1,115 patients with low-risk prostate cancer. No androgen suppression was given. Patients were stratified according to Gleason score 2–4 and Gleason score 5–6.”


Full Dose Radiotherapy to Whole Breast May Not Be Needed in Early Breast Cancer

“Radiotherapy to the whole breast is standard treatment after breast-conserving surgery for women with early breast cancer, even those who have a low risk of the disease returning in the breast (local relapse). However, whole breast radiotherapy can cause changes in the appearance of the breast, which may also be firmer and tender to the touch, resulting in psychological distress.

” ‘So we considered it important to set up a trial to answer the question: is full dose radiotherapy to whole breast needed in patients with low risk early breast cancer?’ Dr Charlotte Coles, MD, Consultant Clinical Oncologist at Cambridge University Hospitals NHS Trust, Cambridge, UK, told the 10th European Breast Cancer Conference (EBCC-10) today (Wednesday). One group of women received standard full dose radiotherapy to the whole breast. A second group received standard full dose to breast tissue closest to where the lump appears and a slightly lower dose further away. A third group received standard full dose radiotherapy to breast tissue closest to where the lump appears but no radiotherapy dose apart from this.”


'Risky': Prostate Radiation, Second Cancers Linked

“External-beam radiation for prostate cancer appears to be tied to the development of secondary cancers.

“Compared with other prostate cancer treatment types, the use of radiotherapy was associated with an increased risk for additional cancers in the lower half of the torso, according to a meta-analysis of 21 studies.

“Specifically, there was an increased risk for cancers of the bladder (adjusted hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.55 – 1.80), colorectum (three studies) (HR, 1.79; 95% CI, 1.34 – 2.38), and rectum (HR, 1.79; 95% CI, 1.34 – 2.38).”


Does Radiation Therapy Improve Survival for Women With Ductal Carcinoma in Situ?

“Approximately 60,000 patients in the United States will receive a diagnosis of ductal carcinoma in situ (DCIS) in 2016. DCIS is not an invasive form of cancer and the 10-year survival rate for women with DCIS is greater than 98 percent. However, incidence of DCIS has increased dramatically over the last three decades, and being able to determine which women are among the small percentage at higher risk of breast cancer recurrence and mortality could help clinicians and patients tailor treatment to neither over treat nor under treat the disease. Investigators from Brigham and Women’s Hospital (BWH) and the Dana-Farber Cancer Institute have found that a set of easily measurable risk factors can predict the magnitude of survival benefit offered by radiation therapy following breast cancer surgery. Their results appear online in the Journal of Clinical Oncology on Feb. 1.”


Recommendation to Omit Radiation Therapy After Lumpectomy Is Not Frequently Implemented

“Nearly two thirds of U.S. women age 70 or older with stage I breast cancer who undergo lumpectomy and are eligible to safely omit subsequent radiation therapy (RT) according to national cancer guidelines still receive this treatment, according to new study results. The researchers looked at more than 205,000 cases of breast cancer nationwide, and their study is published as an ‘article in press’ on the Journal of the American College of Surgeons website in advance of print publication.

“After a lumpectomy, also called a breast-sparing or breast-conserving operation, radiation usually is given to the breast to reduce the chance of the cancer returning. However, treatment recommendations changed in 2004 for a select group of elderly breast cancer patients after research found that postoperative RT did not significantly prolong their survival over five years compared with women who received no RT.”


Radiation/Immunotherapy Combos Slow to Gain Traction, But Have Potential in Prostate Cancer

“The surface has only been scratched in the investigation of radiation and immunotherapy in combination for the treatment of patients with prostate cancer, says Steven Finkelstein, MD, of 21st Century Oncology.

“ ‘There is so much undiscovered territory with respect to this research. The fact there that are only a few clinical trails now of any significance in this area means that we need to do more work,’ says Finkelstein, a Scottsdale board certified radiation oncologist, adjunct associate professor at Translational Genomic Research Institute, and executive director of the Arizona Cancer Research Alliance. ‘I’ve spent a career working on this topic, and only now, after 20 years, are we starting to make progress.’

“While progress has been slow, the outlook is bright for the use of immunotherapy and radiation together in prostate cancer, says Finkelstein. He is currently working on a multicenter trial, which is investigating the effects of radiation therapy to augment anti-tumor responses from immunotherapy with sipuleucel-T (Provenge).”