Parameters Associated With 6 Cycles of Radium-223 Dichloride Therapy in Metastatic Castrate-Resistant Prostate Cancer

Abstract

To Review the demographic characteristics and outcome by treatment modalities of patients with adrenocortical carcinoma (ACC) treated in a major Canadian cancer center over a 40-year period and to evaluate the possible role of radiation therapy (RT) Materials/Methods: A retrospective chart review for ACC patients treated in a major cancer center between January 1974 and December 2013 was conducted. Patient demographic and tumor characteristics were extracted. Date of referral to the cancer center and primary and adjuvant treatment modality were recorded. Outcome data were collected including dates and sites of failure. Vital status and cause of death were determined. Overall survival and disease-free survival curves were created using Kaplan Meier analysis. Results: Out of 81 patients identified, 39 had ACC. The median age was 46 years (range: 18-82 years). There were 25 (64%) female and 14 (36%) male patients. None had genetic syndromes or a family history of endocrinal malignancy except for one patient who had a family history of pheochromocytoma. The most common presenting symptom is abdominal pain (16 patients, 41%) and Cushing syndrome (4 patients, 10%). Eight patients had incidental adrenal mass found during investigation for another reason. Most patients were first seen by surgeons: urologists (10, 25%) or general surgeons (5, 13%). When referred to the cancer center, they are mainly referred to medical oncologists. CAT-scan (CT) is the main imaging modality for diagnosis and follow-up. Data are available for 27 patients, all of whom had a CT. Six of these patients had magnetic resonance imaging in addition. Eleven patients (28%) had T2, 5 (12%) had T3, 4 (9%) were T4, and 14 (35%) unknown cT stage. Eight patients (20%) presented with metastatic disease on the first referral to the cancer center. Thirty-two patients had surgical resections, including 2 M1 patients; 6 patients did not have surgical resection, 4 of them were metastatic and 2 were nonresectable or medically inoperable. Out of the 32 patients who had surgeries, 16 had adjuvant systemic treatment including mitotane or concurrent chemoradiation; only 6 patients had adjuvant RT. Of those 6 pts, 3 are still alive (2 of them are alive with distant failure). At a median follow-up period of 3.8 years, 28 patients had died (71%), 10 were alive (25%), and the status of one was unknown. Of the 26 patients with known failure, 22 had failure data: 2 of them were local failure, and the rest were distant. Conclusion: ACC is a rare disease with poor prognosis. The current data are insufficient to make treatment recommendations. Randomized controlled studies are currently underway to define the role of adjuvant mitotane. Prospective database and collaborative studies are necessary to study the natural history of the disease and to assess different treatment modalities and their outcome. We recommend creating a prospective national database to allow the opportunity for further research into the role of radiation therapy in these tumors.

Real-World Outcomes of Radium-223 Dichloride for Metastatic Castration Resistant Prostate Cancer

“…More hospital admissions and blood transfusions occurred in patients with one to five Ra-223 injections, which were likely a sign of disease progression since Ra-223 has a low myelotoxic profile with no differences in rate of hematologic complications (i.e., anemia and blood transfusion) compared with placebo in ALSYMCPA [24,25]. Treatment completion could have a positive effect on OS as reported by previous studies [18,26,27]. However, results on the effect of treatment completion and OS have to be interpreted with caution due to the effect of immortal time bias.…”

Real-world Outcomes and Factors Predicting Survival and Completion of Radium 223 in Metastatic Castrate-resistant Prostate Cancer

“…In our cohort, median overall survival in Group 1-4 was 4.5 months and Group 5-6 was 18.6 months (Figure 1a). In a similar retrospective study, Stolten et al reported median overall survival of 16 months for those who completed 6 cycles of Ra-223 vs. 4 months for those who completed fewer than 6 cycles [11].Furthermore, median overall survival for patients who received 1-4 Ra-223 cycles vs. 5-6 cycles was 6.2 vs. 17.9 months in ALSYMPCA trial and 6.3 vs. >16 months in the international Expanded Access Program (iEAP) [10].…”

Review of Palliative 223Ra in Metastatic Castration-Resistant Prostate Cancer: Experience at West Virginia University Cancer Center

“…However, postapproval real-world experience with 223 Ra in mCRPC has often found shorter median survival and greater complication rates than reported by the ALSYMPCA trial (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”