Impact of timing on salvage radiation therapy adverse events following radical prostatectomy: A secondary analysis of the RTOG 9601 cohort

Baumgarten, Lee; Borchert, Alex; Sood, Akshay; Dalela, Deepansh; Arora, Sohrab; Keeley, Jacob; Rogers, Craig G.; Peabody, James O.; Menon, Mani; Abdollah, Firas

doi:10.1016/j.urolonc.2019.09.012

Cited by 5 publications

(3 citation statements)

References 21 publications

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“… 13 These patients may also be told that early sRT will not affect the recovery of their urinary control adversely, as shown by a recent study evaluating the effect of timing of sRT on urinary control. 14 …”

Section: Discussionmentioning

confidence: 99%

Anti-Androgen Therapy Overcomes the Time Delay in Initiation of Salvage Radiation Therapy and Rescues the Oncological Outcomes in Men with Recurrent Prostate Cancer After Radical Prostatectomy: A Post Hoc Analysis of the RTOG-9601 Trial Data

et al. 2022

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Background It is unknown whether the addition of anti-androgen therapy (AAT) to late salvage radiation therapy (sRT) can lead to oncological outcomes equivalent to that of early sRT in men with recurrent prostate cancer (CaP) after surgery. Methods Data on 670 men who participated in the Radiation Therapy Oncology Group (RTOG)-9601 trial and who experienced biochemical recurrence were extracted using the National Clinical Trials Network (NCTN) data archive platform. Patients were stratified into four treatment groups: early sRT (pre-sRT prostate-specific antigen [PSA] < 0.7 ng/mL) and late sRT (pre-sRT PSA ≥ 0.7 ng/mL) with/without concomitant AAT, based on cut-offs reported in the original trial. Time-varying Cox proportional hazards and Fine–Gray competing-risk regression analyses assessed the adjusted hazards of overall mortality, CaP-specific mortality, and metastasis among the four treatment groups. Results At 15-years (median follow-up of 14.7 years), for patients treated with early sRT, early sRT with AAT, late sRT, and late sRT with AAT, the overall mortality, CaP-specific mortality, and metastasis rates were 22.9, 22.8, 40.1, and 22.9% (log-rank p = 0.0039), 12.1, 3.9, 22.7, and 8.0% (Gray’s p = 0.0004), and 18.8, 14.6, 35.9, and 19.5% (Gray’s p = 0.0004), respectively. Time-varying multivariable adjusted analysis demonstrated increased hazards of overall mortality in patients receiving delayed sRT versus early sRT (hazards ratio [HR] 1.49, 95% confidence interval [CI] 1.02–2.17); however, no difference remained after the addition of concomitant AAT to late sRT (HR 0.85, 95% CI 0.55–1.32, referent early sRT). Likewise, the hazards of cancer-specific mortality and metastatic progression were worse for late sRT when compared with early sRT, but were no different after the addition of AAT to late sRT. Conclusions Poorer outcomes associated with late sRT in men with recurrent CaP may be rescued by delivery of concomitant AAT.

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Section: Discussionmentioning

confidence: 99%

Anti-Androgen Therapy Overcomes the Time Delay in Initiation of Salvage Radiation Therapy and Rescues the Oncological Outcomes in Men with Recurrent Prostate Cancer After Radical Prostatectomy: A Post Hoc Analysis of the RTOG-9601 Trial Data

et al. 2022

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“…In our cohort, few patients received salvage ADT. In fact, results from RTOG 9601 (24 months bicalutamide during and after sRT) [22] and GETUG-AFU 16 (goserelin on the first day of sRT and at 3 months) [23] have since supported the use of concomitant ADT, which is now recommended by ASTRO/AUA guidelines. [24] Since this cohort was treated before long follow-up results from these randomized clinical trials were made available, ADT was not standard in our Institution and, therefore, PSA follow-up was included from the conclusion of sRT in most patients.…”

Section: Discussionmentioning

confidence: 99%

Pathological stage, surgical margin and lymphovascular invasion as prognostic factors after salvage radiotherapy for post-prostatectomy relapsed prostate cancer — outcomes and optimization strategies

Rodrigues

Ferreira

Gonçalves

et al. 2021

Rep Pract Oncol Radiother.

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“…Not only are positive surgical margins associated with unfavourable oncological outcomes, but they also often imply additional adjuvant radiation and androgen deprivation therapy, both of which are associated with a considerable number of adverse short-and long-term side effects [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Identification of patients at risk for biochemical recurrence after radical prostatectomy with intra‐operative frozen section

et al. 2021

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To identify patients at risk for biochemical recurrence (BCR) of prostate cancer (PCa) after radical prostatectomy (RP) with intra-operative whole-mount frozen section (FS) of the prostate. Material and MethodsWe examined differences in BCR between patients with initial negative surgical margins at FS, patients with final negative surgical margins with initial positive margins at FS without residual PCa after secondary tumour resection, and patients with final negative surgical margins with initially positive margins at FS with residual PCa in the secondary tumour resection specimen. Institutional data of 883 consecutive patients undergoing RP were collected. Intra-operative wholemount FS was routinely used to check for margin status and, if necessary, to resect more periprostatic tissue in order to achieve negative margins. Patients with lymph node-positive disease or final positive surgical margins were excluded from the analysis. KaplanÀMeier curves and multivariable Cox proportional hazards regression analyses adjusting for clinical covariates were employed to examine differences in biochemical recurrence-free survival (BRFS) according to the resection status mentioned above. ResultsThe median follow-up was 22.4 months. The 1-and 2-year BRFS rates in patients with (81.0% and 72.9%, respectively; P = 0.001) and without residual PCa (90.3% and 82.3%, respectively; P = 0.033) after secondary tumour resection were significantly lower compared to patients with initial R0 status (93.4% and 90.9%, respectively). On multivariable Cox regression only residual PCa in the secondary tumour resection was associated with a higher risk of BCR compared to initial R0 status (hazard ratio 1.99, 95% confidence interval 1.01-3.92; P = 0.046). ConclusionDespite being classified as having a negative surgical margin, patients with residual PCa in the secondary tumour resection specimen face a high risk of BCR. These findings warrant closer post-RP surveillance of this particular subgroup. Further research of this high-risk subset of patients should focus on examining whether these patients benefit from early salvage therapy and how resection status impacts oncological outcomes in the changing landscape of PCa treatment.

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Impact of timing on salvage radiation therapy adverse events following radical prostatectomy: A secondary analysis of the RTOG 9601 cohort

Cited by 5 publications

References 21 publications

Anti-Androgen Therapy Overcomes the Time Delay in Initiation of Salvage Radiation Therapy and Rescues the Oncological Outcomes in Men with Recurrent Prostate Cancer After Radical Prostatectomy: A Post Hoc Analysis of the RTOG-9601 Trial Data

Anti-Androgen Therapy Overcomes the Time Delay in Initiation of Salvage Radiation Therapy and Rescues the Oncological Outcomes in Men with Recurrent Prostate Cancer After Radical Prostatectomy: A Post Hoc Analysis of the RTOG-9601 Trial Data

Pathological stage, surgical margin and lymphovascular invasion as prognostic factors after salvage radiotherapy for post-prostatectomy relapsed prostate cancer — outcomes and optimization strategies

Identification of patients at risk for biochemical recurrence after radical prostatectomy with intra‐operative frozen section

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