Adenoid Cystic Carcinoma/Basal Cell Carcinoma of the Prostate: Overview and Update on Rare Prostate Cancer Subtypes

Cozzi, Salvatore; Bardoscia, Lilia; Najafi, M. Hassan; Botti, A.; Blandino, Gladys; Augugliaro, Matteo; Manicone, M.; Iori, Federico; Giaccherini, L.; Sardaro, Angela; Iotti, C.; Ciammella, Patrizia

doi:10.3390/curroncol29030152

Cited by 13 publications

(19 citation statements)

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“…Radiotherapy plays a crucial role in the management of PC with curative intent as well as in the salvage setting. Emerging data have established RT as a useful therapeutic option also for oligometastatic and oligorecurrent/oligoprogressive disease [16], rare histologies [17,18], or in combination with new drugs available for hormone-sensitive and castration-resistant PC. In recent years, advances in radiation planning and delivery techniques, in particular the advent of new-generation linac with the FFF mode, have improved treatment accuracy and given rise to the adoption of ultrahypofractionated radiation schedules in the form of SBRT [19] in different oncological settings, with acceptable toxicity [20][21][22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

Cozzi

Ghersi

Bardoscia³

et al. 2023

Strahlenther Onkol

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Background The rates of local failure after curative radiotherapy for prostate cancer (PC) remain high despite more accurate locoregional treatments available, with one third of patients experiencing biochemical failure and clinical relapse occurring in 30–47% of cases. Today, androgen deprivation therapy (ADT) is the treatment of choice in this setting, but with not negligible toxicity and low effects on local disease. Therefore, the treatment of intraprostatic PC recurrence represents a challenge for radiation oncologists. Prostate reirradiation (Re-I) might be a therapeutic possibility. We present our series of patients treated with salvage stereotactic Re‑I for intraprostatic recurrence of PC after radical radiotherapy, with the aim of evaluating feasibility and safety of linac-based prostate Re‑I. Materials and methods We retrospectively evaluated toxicities and outcomes of patients who underwent salvage reirradiation using volumetric modulated arc therapy (VMAT) for intraprostatic PC recurrence. Inclusion criteria were age ≥ 18 years, histologically proven diagnosis of PC, salvage Re‑I for intraprostatic recurrence after primary radiotherapy for PC with curative intent, concurrent/adjuvant ADT with stereotactic body radiation therapy (SBRT) allowed, performance status ECOG 0–2, restaging choline/PSMA-PET/TC and prostate MRI after biochemical recurrence, and signed informed consent. Results From January 2019 to April 2022, 20 patients were recruited. Median follow-up was 26.7 months (range 7–50). After SBRT, no patients were lost at follow-up and all are still alive. One- and 2‑year progression free survival (PFS) was 100% and 81.5%, respectively, while 2‑year biochemical progression-free survival (bFFS) was 88.9%. Four patients (20%) experienced locoregional lymph node progression and were treated with a further course of SBRT. Prostate reirradiation allowed the ADT start to be postponed for 12–39 months. Re‑I was well tolerated by all patients and none discontinued the treatment. No cases of ≥ G3 genitourinary (GU) or gastrointestinal (GI) toxicity were reported. Seven (35%) and 2 (10%) patients experienced acute G1 and G2 GU toxicity, respectively. Late GU toxicity was recorded in 10 (50%) patients, including 8 (40%) G1 and 2 (10%) G2. ADT-related side effects were found in 7 patients (hot flashes and asthenia). Conclusion Linac-based SBRT is a safe technique for performing Re‑I for intraprostatic recurrence after primary curative radiotherapy for PC. Future prospective, randomized studies are desirable to better understand the effectiveness of reirradiation and the still open questions in this field.

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Section: Discussionmentioning

confidence: 99%

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

Cozzi

Ghersi

Bardoscia³

et al. 2023

Strahlenther Onkol

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“…Radiotherapy plays a crucial role in the management of PCa, both with curative intent and in the salvage setting. Emerging data have placed RT as a useful therapeutic option also for oligometastatic and oligorecurrent/oligoprogressive disease (22), rare histologies (23)(24)(25), or in combination with new drugs available for hormone-sensitive and castrateresistant PCa.…”

Section: Discussionmentioning

confidence: 99%

Moderately Hypofractionated Helical Tomotherapy for Prostate Cancer: Ten-year Experience of a Mono-institutional Series of 415 Patients

Cozzi

Ruggieri

Alì

et al. 2023

In Vivo

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Background/Aim: Radiotherapy represents an important therapeutic option in the management of prostate cancer (PCa). As helical tomotherapy may improve toxicity outcomes, we aimed to evaluate and report the toxicity and clinical outcomes of localized PCa patients treated with moderately hypofractionated helical tomotherapy. Patients and Methods: We retrospectively analyzed 415 patients affected by localized PCa and treated with moderately hypofractionated helical tomotherapy in our department from January 2008 to December 2020. All patients were stratified according to the D'Amico risk classification: low-risk 21%, favorable intermediate-risk 16%, unfavorable intermediate-risk 30.4%, and high-risk 32.6%. The dose prescription for high-risk patients was 72.8 Gy to the prostate (planning tumor volume-PTV1), 61.6 Gy to the seminal vesicles (PTV2), and 50.4 Gy to the pelvic lymph nodes (PTV3) in 28 fractions; for low-and intermediate-risk patients 70 Gy for PTV1, 56 Gy for PTV2, and 50.4 Gy for PTV3 in 28 fractions. Image-guided radiation therapy was performed daily in all patients by mega-voltage computed tomography. Forty-one percent of patients received androgen deprivation therapy (ADT). Acute and late toxicity was assessed according to the National Cancer Institute's Common Terminology Criteria for Adverse Events v.5.0 (CTCAE). Results: Median follow-up was 82.7 months (range=12-157 months) and the median age of patients at diagnosis was 72.5 years (range=49-84 years). The 3, 5, and 7 yr overall survival (OS) rates were 95%, 90%, and 84%, respectively, while 3, 5, and 7 yr disease-free survival (DFS) were 96%, 90%, and 87%, respectively. Acute toxicity was as follows: genitourinary (GU) G1 and G2 in 35.9% and 24%; gastrointestinal (GI) in 13.7% and 8%, with G3 or more acute toxicities less than 1%. The late GI toxicity G2 and G3 were 5.3% and 1%, respectively, and the late GU toxicity G2 and G3 were 4.8% and 2.1%, respectively, and only three patients had a G4 toxicity. Conclusion: Hypofractionated helical tomotherapy for PCa treatment appeared to be safe and reliable, with favorable acute and late toxicity rates and encouraging results in terms of disease control.External beam radiotherapy is a milestone in the treatment of men with prostate cancer (PCa) with curative intent and is associated with long-term disease control in most patients (1). Historically, the standard radiotherapy treatment involves conventional fractionation, with doses of 1.8-2 Gy/day, treatment approximately over 7 weeks, with onerous costs and a negative impact on the patient's quality of life (2, 3). Over the last decade, the constant improvement in radiotherapy techniques, including intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT), has led to more personalized treatment, with the possibility of using doseescalated schedules with significant advantages in terms of biochemical control rates and cost-effectiveness (5, 6). Helical tomotherapy, with a combination of linear accelerator and computed tomography chara...

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“…Indeed, basal cell carcinoma of the prostate is a rare prostate cancer subtype. Importantly, similar to the basal cell carcinoma in situ of the skin as the non-invasive variant of cutaneous basal cell carcinoma, basal cell carcinoma in situ of the prostate has recently been described [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Basal Cell Carcinoma In Situ: A Case Series

Cohen¹

2022

Cureus

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Basal cell carcinoma, squamous cell carcinoma, and melanoma are three types of skin cancers. Skin cancers present as either non-invasive malignancies or invasive neoplasms. The non-invasive malignancies are referred to as carcinoma in situ; they only have cancer cells that are restricted to the epidermis and are not present as single tumor cells or independent nests of malignant cells in the underlying dermis. In contrast, invasive neoplasms demonstrate individual malignant cells or aggregates of tumor cells or both that are found in the dermis; in addition, cancer cells may also be located in the overlying epidermis. The features of three men with basal cell carcinoma in situ of the skin are described in this case series. Each of their tumors morphologically appeared as a red, scaly or non-scaly, and superficial plaque on the abdomen or the back; the neoplasm was successfully treated without recurrence by either surgical excision or by topical 5% imiquimod cream. Cutaneous basal cell carcinoma in situ has characteristic morphologic and pathologic findings. Clinically, cancer most commonly appears as a thin, smooth-surfaced or scaly, and as an erythematous plaque on the trunk. Microscopic examination shows multiple sites of basaloid tumor cells that either nearly filled the epidermis and/or replaced the lower layers of the epidermis; the aggregates of tumor cells may expand the epidermis and display slight extension into the papillary dermis. However, there is no contiguous invasion of the tumor cells from the overlying epidermis into the underlying dermis. Palisading of the peripheral tumor cells is noted; in addition, focally, retraction of the dermal stroma from the tumor is also frequently present. Lymphocytic inflammation may also be present in the upper dermis. Similar to the reported patients, since basal cell carcinoma in situ of the skin is only localized to the epidermis, several therapeutic modalities are available to effectively treat the cancer. However, if the basal cell carcinoma in situ represents the superficial portion of a basal cell carcinoma of mixed histology, tumor persistence or recurrence may occur if a more conservative approach to treatment is utilized that does not adequately treat the unsuspected and more aggressive pathologic subtype of basal cell carcinoma in the underlying dermis. In summary, basal cell carcinoma in situ of the skin has a unique clinicopathologic correlation of morphology, histology, tumor biology, and response to treatment; indeed, tumors that were previously classified as superficial basal cell carcinoma are more appropriately designated as cutaneous basal cell carcinoma in situ.

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Adenoid Cystic Carcinoma/Basal Cell Carcinoma of the Prostate: Overview and Update on Rare Prostate Cancer Subtypes

Cited by 13 publications

References 46 publications

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

Moderately Hypofractionated Helical Tomotherapy for Prostate Cancer: Ten-year Experience of a Mono-institutional Series of 415 Patients

Cutaneous Basal Cell Carcinoma In Situ: A Case Series

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