Combination of Adjuvant Hormonal and Radiation Therapy Significantly Prolongs Survival of Patients With pT2–4 pN+ Prostate Cancer: Results of a Matched Analysis

Briganti, Alberto; Karnes, R. Jeffrey; Pozzo, L. Da; Cozzarini, C.; Capitanio, Umberto; Gallina, Andrea; Suardi, Nazareno; Bianchi, Marco; Tutolo, Manuela; Salonia, Andrea; Muzio, N. Di; Rigatti, Patrìzio; Montorsi, Francesco; Blute, Michael L.

doi:10.1016/j.eururo.2011.02.024

Cited by 186 publications

(98 citation statements)

References 30 publications

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“…Briganti et al performed a matched analysis comparing adjuvant whole pelvis EBRT with ADT versus ADT alone in patients with LNI after RP and ePLND. 47 Adjuvant whole pelvis EBRT consisted of a 4-field whole pelvis irradiation to a median dose of 50.4 Gy followed by a 3-field boost to the prostatic bed to a median dose of 68.4 Gy. There was a significant benefit of adding whole pelvis EBRT to ADT: 10 year CSS and OS were 86% and 74% respectively versus 70% and 55% for ADT alone.…”

Section: Whole Pelvis Irradiation For Lymph Node Metastasized Pcmentioning

confidence: 99%

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Developments in External Beam Radiotherapy for Prostate Cancer

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et al. 2013

Urology

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Section: Whole Pelvis Irradiation For Lymph Node Metastasized Pcmentioning

confidence: 99%

“…The gain in survival benefit seems thus most pronounced in patients with gross nodal disease. 47 Some patients are unfit or refuse to undergo RP. In these patients, primary EBRT is indicated.…”

Section: Whole Pelvis Irradiation For Lymph Node Metastasized Pcmentioning

confidence: 99%

Developments in External Beam Radiotherapy for Prostate Cancer

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et al. 2013

Urology

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“…Aggressive local therapy seems to be effective in this setting as well. Two retrospective studies showed [ 9 1 _ T D $ D I F F ] the addition of RT and ADT after local therapy with RP and PLND improved survival in occult nodal disease, regardless of the number of positive lymph nodes removed at PLND [47,48]. Improved CSS in the retrospective review by Abdollah et al [49] was limited to patients with intermediate-and high-risk nodal disease.…”

Section: Multimodal Therapy In Occult Nodal Disease and Clinically Pomentioning

confidence: 99%

“…Improved CSS in the retrospective review by Abdollah et al [49] was limited to patients with intermediate-and high-risk nodal disease. As all three retrospective reviews were performed at the same institutions,[ 2 2 _ T D $ D I F F ] there is some overlap of identical patients [47][48][49].…”

Section: Multimodal Therapy In Occult Nodal Disease and Clinically Pomentioning

confidence: 99%

Treatment of the Primary Tumor in Metastatic Prostate Cancer: Current Concepts and Future Perspectives

et al. 2016

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“…3,4 Second, using survival end-points and bypassing some biases derived from broad inclusion criteria and heterogeneous characteristics of patients included in RCT, this study provides evidence of the survival benefit of ART for patients presenting with two or more of the following adverse pathological features: LNI, pT3b/4 and Gleason score ≥8.…”

mentioning

confidence: 99%

Editorial Comment from Dr Zilli and Dr Miralbell to Early radiotherapy after radical prostatectomy improves cancer‐specific survival only in patients with highly aggressive prostate cancer: Validation of recently released criteria

Zilli

Miralbell

2014

Int J of Urology

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Using data from the Surveillance, Epidemiology and End Results database, Gandaglia et al. validated in a large cohort of 7616 prostate cancer patients treated with radical prostatectomy (RP) for pT3/4 N0/N1 disease a risk score to select the most optimal candidates for adjuvant radiotherapy (ART) previously elaborated in a single tertiary referral center cohort of 1049 patients.1 As previously observed by Abdollah et al. in patients with ≥2 pathological features (Gleason score 8-10, pT3b/4 disease and/or lymph node invasion [LNI]), RT administered within 6 months after RP significantly improves prostate cancer-specific survival rates; whereas in patients with a lowerrisk score, the addition of RT does not decrease the risk of cancer-related mortality. 2Despite some inherent limitations mentioned by Gandaglia et al., such as the retrospective nature and the absence of postoperative prostate-specific antigen to judge whether the RT was delivered in an adjuvant or salvage setting, this observational cohort study contributes further evidence for the role of ART in the postoperative setting for patients with high-risk disease. The major interest of this study stems from two interesting points of additional value for the clinical community regarding the evidence-based knowledge provided by randomized phase III clinical trials (RCT) of ART versus observation alone.First, compared with RCT of ART for node-negative patients only, this study shows that ART alone or in combination with androgen deprivation can improve the survival of patients with pN1 disease, previously considered as harboring systemic disease.3,4 Second, using survival end-points and bypassing some biases derived from broad inclusion criteria and heterogeneous characteristics of patients included in RCT, this study provides evidence of the survival benefit of ART for patients presenting with two or more of the following adverse pathological features: LNI, pT3b/4 and Gleason score ≥8.However, although this type of study is encouraged to provide additional answers for open clinical questions and to establish a new basis for further prospective trials, because of the lack of level I evidence on the value of early salvage RT, knowledge provided by published RCT should remain the decisional milestone for ART. 5In the context of an individualized multidisciplinary discussion, all patients at high risk of recurrence (positive surgical margins, seminal vesicle invasion, extracapsular extension, but also LNI and Gleason score ≥8) should be offered ART, weighting the potential benefits and risks of adjuvant therapies. Nomograms or scoring systems integrating all clinical and pathological prognostic factors for disease recurrence based on the evidence provided by RCT as well as derived from the study of Gandaglia et al. are therefore welcomed to better discriminate optimal candidates for ART. Incorporating in one single scoring system all these risk features, the postsurgical Cancer Prostate Risk Assessment Score might offer an alternative prognostic tool to better...

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Combination of Adjuvant Hormonal and Radiation Therapy Significantly Prolongs Survival of Patients With pT2–4 pN+ Prostate Cancer: Results of a Matched Analysis

Cited by 186 publications

References 30 publications

Developments in External Beam Radiotherapy for Prostate Cancer

Developments in External Beam Radiotherapy for Prostate Cancer

Treatment of the Primary Tumor in Metastatic Prostate Cancer: Current Concepts and Future Perspectives

Editorial Comment from Dr Zilli and Dr Miralbell to Early radiotherapy after radical prostatectomy improves cancer‐specific survival only in patients with highly aggressive prostate cancer: Validation of recently released criteria

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