Increased Radiation Dose Offers No Survival Benefit for Patients with Low-Risk Prostate Cancer, Penn Study Finds

“Increased radiation dose is associated with higher survival rates in men with medium- and high-risk prostate cancer, but not men with low-risk prostate cancer, according to a new study from Penn Medicine published this week in JAMA Oncology. Already-high survival rates for men with low-risk prostate cancer were unaffected by higher radiation dosages compared to lower radiation dosages.

“In 2014, low-risk prostate cancer was the most common type of prostate cancer diagnosed in the United States, affecting about 150,000 patients, many of whom undergo aggressive treatment, either complete removal of the prostate or radiation.

“ ‘Our study raises the provocative question of whether radiation dose reduction for patients with low-risk prostate cancer could achieve similar cure rates while avoiding the increased risk of side effects associated with higher radiation doses,’ said the study’s lead author, Anusha Kalbasi, MD, a resident in the department of Radiation Oncology at the Perelman School of Medicine at the University of Pennsylvania.”

'Watchful Waiting' Common for Prostate Cancer

“More U.S. physicians are sparing their low-risk prostate cancer patients from surgery, radiation and hormone therapy in favor of monitoring their patients over time — a strategy called watchful waiting, a new study shows.

“The number of low-risk patients who didn’t undergo treatment jumped from as low as 7 percent from 1990-2009 to 40 percent from 2010-2013, the study revealed. These findings indicate that more patients are being monitored to see if their conditions get worse.

“This is ‘excellent news’ about the popularity of ‘active surveillance,’ said study author Dr. Matthew Cooperberg, the Helen Diller Family Chair in Urology at the University of California, San Francisco.

” ‘We expected to see a rise in surveillance rates, but were surprised by the steepness of the trajectory,’ he said. ‘This really does represent a paradigm change, and it’s faster than the typical pace of medical evolution.’ “

Implantable Devices at Risk During During Cancer Radiotherapy

Cancer patients with cardiovascular implantable electronic devices (CIEDs) who require radiotherapy may be at increased risk of a single-event upset malfunction when higher energy neutron-producing radiotherapy is used, a study now shows.

“The retrospective analysis, one of the largest cohorts in which contemporary CIEDs were exposed to photon- and electron-based radiotherapy, demonstrated that more than 10 MV of neutron-producing radiotherapy resulted in a device compromise rate of 21%.

“In 178 courses of non-neutron-producing radiotherapy, however, the device compromise rate was 0%, Jonathan D. Grant, MD, department of radiation oncology, University of Texas MD Anderson Cancer Center, Houston, and colleagues said in an online report in JAMA Oncology.

“Single-event upsets also occurred during neutron-producing radiotherapy at a rate of 10% in pacemakers and 34% in implantable cardioverter-defibrillators per course, Grant said.

“Based on these findings, the investigators recommend that non-neutron-producing radiotherapy be used whenever possible. In cases where higher radiotherapy energies are of clinical benefit, however, they emphasized that ‘error rates and outcomes that we report will aid clinicians in weighing the risks of using neutron-producing radiotherapy.’ “

Short-Course Partial-Breast RT Gets High Marks (CME/CE)

“A week-long course of accelerated partial breast irradiation (APBI) after lumpectomy led to low rates of breast cancer recurrence and a 10-year survival of 96%, investigators in a multi-institutional study reported.

“Patients treated with the interstitial brachytherapy protocol had a 10-year actuarial risk of ipsilateral recurrence of 7.6%, regional failure rate of 2.3%, and distant metastasis rate of 3.8%. High-grade disease at diagnosis and positive surgical margins were the only significant predictors of an increased risk of local recurrence.

“The results compare favorably with those associated with whole-breast irradiation that requires 6 or 7 weeks to complete, Mitchell Kamrava, MD, of the University of California Los Angeles, and co-authors indicated in an article published online in Annals of Surgical Oncology.

” ‘While we await the results of level 1 evidence, these data provide valuable information that 5-day APBI in appropriately selected women can be considered as an alternative to conventional 6- to 7-week external-beam whole-breast irradiation (WBI),’ they concluded.”

Super Patient: John Wagontall Gets a Third Opinion and Survives Prostate Cancer

Update:  We are deeply saddened to report that John passed away on December 18, 2016. It is a privilege to continue to share his story and keep his memory alive.

In the summer of 2004, John Wagontall looked like the picture of health. The 46-year-old Canadian had been a firefighter for 20 years, was an avid cyclist, and also worked out alongside his wife as she trained for a bodybuilding competition. The only sign that something was wrong was a bit of blood in his urine.

His doctor told John he had a bladder infection, prescribed antibiotics, and sent him home. And all appeared to be well until a few months later, when his urine was bloody again. This time, his doctor sent him to a urologist to learn the underlying cause of his recurring bladder infection. Continue reading…

Post-Op Radiation Therapy for Lung Ca Boosts Patient Survival

“Post-operative radiation therapy (PORT) is associated with improved overall survival in patients with incompletely resected stage II or III non-small cell lung cancer (NSCLC,) a review of a large population-based cohort from the National Cancer Data Base indicated.

“In the Journal of Clinical Oncology, Byunghoon Yu, MD, Therapeutic Radiology, Yale School of Medicine, and colleagues reported that although the use of PORT has been on the decline, “our findings strongly support the delivery of PORT in patients with incompletely resected NSCLC.”

“They noted the absence of randomized trials evaluating the use of PORT for this patient population and said that unknown confounders, such as surgical quality and patient motivation, may also be present. ‘As such, our analysis, although robust, should be confirmed using other data sets,’ said Yu.

“In the retrospective survival analysis, 3,395 patients with pathologic stage N0-N2, overall American Joint Committee on Cancer stage II or II NSCLC from 2003 to 2011 were identified. All had undergone a lobectomy or pneumonectomy with positive surgical margins.”

Adding ADT to RT Improved PFS After Radical Prostatectomy

“Assigning men in biological relapse after radical prostatectomy to combined salvage treatment with hormone therapy and radiation therapy significantly delayed disease progression compared with radiation therapy alone, according to the results of the GETUG-AFU 16 phase III trial (abstract 5006).

“ ‘Salvage radiotherapy combined with limited androgen deprivation therapy improves the 5-year progression-free survival rate compared to radiotherapy alone,’ said study presenter Christian Carrie, MD, of the department of radiation oncology at the University of Lyon-Centre Leon Berard. ‘There is no significant difference in overall survival, but the follow-up is still too short.’

“Between October 2006 and March 2010, 743 patients were enrolled in GETUG-AFU 16 and randomly assigned to radiation therapy alone (n = 374) or radiation plus hormone therapy with goserelin 10.8 mg for 6 months (n = 369). The primary endpoint of the trial was progression-free survival.”

Surgery May Boost Survival in Certain Advanced Lung Cancers

“Certain patients with lung cancer that’s spread throughout the chest could live longer by undergoing surgery to remove diseased lung tissue, instead of receiving only chemotherapy and radiation, new research suggests.

“The study was based on a review of data on more than 9,000 patients with stage 3b non-small cell lung cancer—tumors that have spread to lymph nodes or other organs in the chest. The researchers found that those who underwent a combination of surgery, chemotherapy and radiation treatment lived an average of almost 10 months longer than those receiving chemo and radiation alone.

“Typically, surgery isn’t offered to patients with such advanced cases of non-small cell lung cancer, physicians said, and some may also be too ill to undergo the procedure.

“However, ‘we think our study reignites a question that was initially asked in the 1980s and 1990s but has become more or less dormant in lung cancer circles,’ said study author Dr. Varun Puri, an assistant professor of surgery in the division of cardiothoracic surgery at Washington University School of Medicine in St. Louis.

“According to Puri, the take-home message from the study is that ‘we should not consider all stage 3b non-small lung cancer patients as being eligible for only chemo-radiation therapy. An experienced thoracic surgeon should evaluate these patients and decide [if surgery is also an option] on a case-by-case basis.’ “

Adding Chemo Boosts Prostate Cancer Survival

“Mounting evidence supports the addition of docetaxel to standard hormone and radiation treatment in men with high-risk prostate cancer. This latest comes from a federally funded phase 3 clinical trial presented here at this year’s American Society of Clinical Oncology meeting.

“The 4-year overall survival rates were higher with docetaxel than standard therapy. The add-on chemotherapy was given for 18 weeks, starting a month after radiation.

” ‘This finding could improve outcomes for thousands of men,’ lead investigator Howard Sandler, MD, from Cedars-Sinai Medical Center in Los Angeles, said in a statement issued in advance of the news conference on the study. ‘We also expect to see an even bigger survival advantage over time,’ he said.”