1
|
Hallemeier CL, Zhang P, Pisansky TM, Hanks GE, McGowan DG, Roach M, Zeitzer KL, Firat SY, Husain SM, D'Souza DP, Souhami L, Parliament MB, Rosenthal SA, Lukka HR, Rotman M, Horwitz EM, Miles EF, Paulus R, Sandler HM. Prostate-Specific Antigen After Neoadjuvant Androgen Suppression in Prostate Cancer Patients Receiving Short-Term Androgen Suppression and External Beam Radiation Therapy: Pooled Analysis of Four NRG Oncology Radiation Therapy Oncology Group Randomized Clinical Trials. Int J Radiat Oncol Biol Phys 2019; 104:1057-1065. [PMID: 30959123 DOI: 10.1016/j.ijrobp.2019.03.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 03/22/2019] [Accepted: 03/31/2019] [Indexed: 11/12/2022]
Abstract
PURPOSE To validate whether prostate-specific antigen (PSA) level after neoadjuvant androgen suppression (neoAS) is associated with long-term outcome after neoAS and external beam radiation therapy (RT) with concurrent short-term androgen suppression (AS) in patients with prostate cancer. METHODS AND MATERIALS This study included 2404 patients. The patients were treated with neoAS before RT and concurrent AS (without post-RT AS) and were pooled from NRG Oncology/RTOG trials 9202, 9408, 9413, and 9910. Multivariable models were used to test associations between the prespecified dichotomized post-neoAS, pre-RT PSA level (≤0.1 vs >0.1 ng/mL) groupings, and clinical outcomes. RESULTS The median follow-up for surviving patients was 9.4 years. The median post-neoAS, pre-RT PSA level was 0.3 ng/mL, with 32% of patients having levels ≤0.1 ng/mL. Race, Gleason score, tumor stage, node stage, pretreatment PSA level, and duration of neoAS were associated with the groups of patients with PSA levels ≤0.1 and >0.1 ng/mL. In univariate analyses, post-neoAS, pre-RT PSA level >0.1 ng/mL was associated with increased risks of biochemical failure (hazard ratio [HR], 2.04; P < .0001); local failure (HR, 2.51; P < .0001); distant metastases (HR, 1.73; P = .0006); cause-specific mortality (HR, 2.36; P < .0001); and all-cause mortality (HR, 1.24; P = .005). In multivariable models that also included baseline and treatment variables, post-neoAS, pre-RT PSA level >0.1 ng/mL was independently associated with increased risk of biochemical failure (HR, 2.00; P < .0001); local failure (HR, 2.33; P < .0001); and cause-specific mortality (HR, 1.75; P = .03). CONCLUSIONS Patients with a PSA level >0.1 ng/mL after neoAS and before the start of RT had less favorable clinical outcomes than patients whose PSA level was ≤0.1 ng/mL. The role of post-neoAS, pre-RT PSA level relative to PSA levels obtained along the continuum of medical care is not presently defined but could be tested in future clinical trials.
Collapse
Affiliation(s)
| | - Peixin Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | | | - Mack Roach
- University of California, San Francisco, San Francisco, California
| | | | - Selim Y Firat
- Medical College of Wisconsin-Zablocki VA Medical Center, Milwaukee, Wisconsin
| | | | | | - Luis Souhami
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Himanshu R Lukka
- McMaster University, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | - Edward F Miles
- Naval Medical Center Accruals Dartmouth Hitchcock Medical Center, Portsmouth, Virginia
| | - Rebecca Paulus
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | |
Collapse
|
2
|
Rotman M, Andela CD, Majoor BCJ, Dijkstra PDS, Hamdy NAT, Kaptein AA, Appelman-Dijkstra NM. Passive Coping Strategies Are Associated With More Impairment In Quality Of Life In Patients With Fibrous Dysplasia. Calcif Tissue Int 2018; 103:469-475. [PMID: 29948062 PMCID: PMC6182587 DOI: 10.1007/s00223-018-0441-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/05/2018] [Indexed: 01/14/2023]
Abstract
Impairments in quality of life (QoL) have been reported in patients with fibrous dysplasia (FD). Here, we examine coping strategies in FD and assess whether these coping strategies are associated with QoL and disease severity. Ninety-two patients (66% females) filled out the Utrecht Coping List (UCL), Short Form-36, and the Brief Pain Inventory (BPI). Coping strategies of patients with FD were compared with reference data from a random sample of Dutch women and patients with chronic pain. Compared to healthy adults, patients expressed more emotions (p < 0.01). Compared to patients with chronic pain, patients with FD used more active coping strategies (p < 0.001), and sought more distraction (p = 0.01) and more social support (p < 0.001). Using more passive coping strategies was associated with more impairment in social function, physical role, mental health, vitality (all p < 0.001), and general health (p < 0.01). Using more avoidant coping strategies was associated with worse mental health and less vitality (both p < 0.01). More expression of emotions was associated with worse mental health (p < 0.01). Type and clinical severity of FD were not associated with coping behavior. Patients with FD have different coping strategies compared to random Dutch reference populations with or without pain. In FD, using more passive coping strategies was associated with more impairment in several aspects of QoL. There was no relationship between coping behavior and clinical characteristics, pointing to biomedical variables not determining the way patients cope with their illness. Recognition of less effective coping strategies can be helpful in the understanding and adaptation of these coping strategies, improving personalized clinical care, with the ultimate goal to improve QoL in patients with FD.
Collapse
Affiliation(s)
- M Rotman
- Division of Endocrinology, Department of Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Orthopedic Surgery, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands.
- Department of Internal Medicine, LUMC Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - C D Andela
- Division of Endocrinology, Department of Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - B C J Majoor
- Department of Orthopedic Surgery, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - P D S Dijkstra
- Department of Orthopedic Surgery, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - N A T Hamdy
- Division of Endocrinology, Department of Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - A A Kaptein
- Department of Medical Psychology, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - N M Appelman-Dijkstra
- Division of Endocrinology, Department of Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
3
|
Majoor BCJ, Andela CD, Quispel CR, Rotman M, Dijkstra PDS, Hamdy NAT, Kaptein AA, Appelman-Dijkstra NM. Illness Perceptions are Associated with Quality of Life in Patients with Fibrous Dysplasia. Calcif Tissue Int 2018; 102:23-31. [PMID: 29022055 PMCID: PMC5760610 DOI: 10.1007/s00223-017-0329-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/14/2017] [Indexed: 12/31/2022]
Abstract
Fibrous dysplasia (FD) is a rare bone disorder in which normal bone is replaced by fibrous tissue resulting in pain, deformities, pathological fractures or asymptomatic disease. Illness perceptions are patients' cognitions and emotions about their illness and its treatment, which may impact on Quality of Life (QoL). Here, we explore illness perceptions in patients with FD compared to other disorders, identify factors associated with illness perceptions and evaluate their relationship with QoL. Ninety-seven out of 138 eligible patients from the LUMC FD cohort completed the Illness Perception Questionnaire-Revised (IPQ-R) and the Short Form-36 (SF-36). Age, Gender, Skeletal Burden Score (SBS), FGF-23 levels, type of FD and SF-36 scores were analysed for an association with illness perceptions. We observed significant (p < 0.01) differences in patients' illness perceptions between FD subtypes in the domains: identity, timeline acute/chronic and consequences. Patients with craniofacial FD reported to perceive more consequences (p = 0.022). High SBS was associated with perceiving more negative consequences and attributing the cause of FD to psychological factors (p < 0.01), and high FGF-23 levels with attributing more symptoms to the disease and perceiving more consequences (p < 0.01). The IPQ-R domain identity, timeline acute/chronic, timeline cyclical, consequences, emotional representations and treatment control were significantly associated with impairments in QoL. Illness perceptions in patients with FD relate to QoL, differ from those in patients with other disorders, and are associated with disease severity. Identifying and addressing maladaptive illness perceptions may improve quality of life in patients with FD.
Collapse
Affiliation(s)
- B C J Majoor
- Department of Orthopaedic Surgery, Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, Postzone J11, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - C D Andela
- Division Endocrinology, Department of Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - C R Quispel
- Department of Orthopaedic Surgery, Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, Postzone J11, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - M Rotman
- Division Endocrinology, Department of Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - P D S Dijkstra
- Department of Orthopaedic Surgery, Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, Postzone J11, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - N A T Hamdy
- Division Endocrinology, Department of Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - A A Kaptein
- Department of Medical Psychology, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| | - N M Appelman-Dijkstra
- Division Endocrinology, Department of Medicine, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
4
|
Nichols RC, Hu C, Bahary JP, Zeitzer KL, Souhami L, Leibenhaut MH, Rotman M, Gore EM, Balogh AG, McGowan D, Michalski J, Raben A, Rudoler S, Jones CU, Sandler H. Serum testosterone changes in patients treated with radiation therapy alone for prostate cancer on NRG oncology RTOG 9408. Adv Radiat Oncol 2017; 2:608-614. [PMID: 29204528 PMCID: PMC5707413 DOI: 10.1016/j.adro.2017.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/27/2017] [Accepted: 07/12/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives We reviewed testosterone changes for patients who were treated with radiation therapy (RT) alone on NRG oncology RTOG 9408. Methods and materials Patients (T1b-T2b, prostate-specific antigen <20 ng/mL) were randomized between RT alone and RT plus 4 months of androgen ablation. Serum testosterone (ST) levels were investigated at enrollment, RT completion, and the first follow-up 3 months after RT. The Wilcoxon signed rank test was used to compare pre- and post-treatment ST levels in patients who were randomized to the RT-alone arm. Results Of 2028 patients enrolled, 992 patients were randomized to receive RT alone and 917 (92.4%) had baseline ST values available and completed RT. Of these 917 patients, immediate and 3-month post-RT testosterone levels were available for 447 and 373 patients, respectively. Excluding 2 patients who received hormonal therapy off protocol after RT, 447 and 371 patients, respectively, were analyzed. For all patients, the median change in ST values at completion of RT and at 3-month follow-up were −30.0 ng/dL (p5-p95; −270.0 to 162.0; P < .001) and −34.0 ng/dL (p5-p95, −228.0 to 160.0; P < .01), respectively. Conclusion RT for prostate cancer was associated with a median 9.2% decline in ST at completion of RT and a median 9.3% decline 3 months after RT. These changes were statistically significant.
Collapse
Affiliation(s)
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania.,Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean-Paul Bahary
- Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal, Quebec, Canada
| | | | | | | | | | - Elizabeth M Gore
- Medical College of Wisconsin and Zablocki VA Medical Center, Milwaukee, Wisconsin
| | | | | | | | - Adam Raben
- Christiana Care Health Services, Inc. CCOP, Newark, Delaware
| | - Shari Rudoler
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | |
Collapse
|
5
|
Davidson S, Emonts R, Rotman M. ASSESSMENT, HOME SAFETY AND THE COGNITIVE PERFORMANCE TEST: A DISCONNECT IN PRACTICE OR PURPOSE? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S. Davidson
- Occupational Therapy, Baycrest Health Sciences, Toronto, Ontario, Canada,
- University of Toronto, Toronto, Ontario, Canada
| | - R. Emonts
- University of Toronto, Toronto, Ontario, Canada
| | - M. Rotman
- University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Rosenthal SA, Hunt D, Sartor AO, Pienta KJ, Gomella L, Grignon D, Rajan R, Kerlin KJ, Jones CU, Dobelbower M, Shipley WU, Zeitzer K, Hamstra DA, Donavanik V, Rotman M, Hartford AC, Michalski J, Seider M, Kim H, Kuban DA, Moughan J, Sandler H. A Phase 3 Trial of 2 Years of Androgen Suppression and Radiation Therapy With or Without Adjuvant Chemotherapy for High-Risk Prostate Cancer: Final Results of Radiation Therapy Oncology Group Phase 3 Randomized Trial NRG Oncology RTOG 9902. Int J Radiat Oncol Biol Phys 2015. [PMID: 26209502 DOI: 10.1016/j.ijrobp.2015.05.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Long-term (LT) androgen suppression (AS) with radiation therapy (RT) is a standard treatment of high-risk, localized prostate cancer (PCa). Radiation Therapy Oncology Group 9902 was a randomized trial testing the hypothesis that adjuvant combination chemotherapy (CT) with paclitaxel, estramustine, and oral etoposide plus LT AS plus RT would improve overall survival (OS). METHODS AND MATERIALS Patients with high-risk PCa (prostate-specific antigen 20-100 ng/mL and Gleason score [GS] ≥ 7 or clinical stage ≥ T2 and GS ≥ 8) were randomized to RT and AS (AS + RT) alone or with adjuvant CT (AS + RT + CT). CT was given as four 21-day cycles, delivered beginning 28 days after 70.2 Gy of RT. AS was given as luteinizing hormone-releasing hormone for 24 months, beginning 2 months before RT plus an oral antiandrogen for 4 months before and during RT. The study was designed based on a 6% improvement in OS from 79% to 85% at 5 years, with 90% power and a 2-sided alpha of 0.05. RESULTS A total of 397 patients (380 eligible) were randomized. The patients had high-risk PCa, 68% with GS 8 to 10 and 34% T3 to T4 tumors, and median prostate-specific antigen of 22.6 ng/mL. The median follow-up period was 9.2 years. The trial closed early because of excess thromboembolic toxicity in the CT arm. The 10-year results for all randomized patients revealed no significant difference between the AS + RT and AS + RT + CT arms in OS (65% vs 63%; P=.81), biochemical failure (58% vs 54%; P=.82), local progression (11% vs 7%; P=.09), distant metastases (16% vs 14%; P=.42), or disease-free survival (22% vs 26%; P=.61). CONCLUSIONS NRG Oncology RTOG 9902 showed no significant differences in OS, biochemical failure, local progression, distant metastases, or disease-free survival with the addition of adjuvant CT to LT AS + RT. The trial results provide valuable data regarding the natural history of high-risk PCa treated with LT AS + RT and have implications for the feasibility of clinical trial accrual and tolerability using CT for PCa.
Collapse
Affiliation(s)
- Seth A Rosenthal
- Radiation Oncology, Sutter Cancer Centers, Roseville, California.
| | - Daniel Hunt
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | - Leonard Gomella
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | - Kevin J Kerlin
- Community Clinical Oncology Program, Southeast Cancer Control Consortium, Inc, Winston-Salem, North Carolina
| | - Christopher U Jones
- Radiation Oncology, Sutter Cancer Centers, Roseville, California; Radiological Associates of Sacramento, Sacramento, California
| | | | - William U Shipley
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Marvin Rotman
- State University of New York Health Science Center-Brooklyn, Brooklyn, New York
| | | | | | | | - Harold Kim
- Wayne State University, Detroit, Michigan
| | - Deborah A Kuban
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | |
Collapse
|
7
|
Affiliation(s)
- M Rotman
- Department of Radiation Oncology, State University of New York, N.Y
| | | | | |
Collapse
|
8
|
Schreiber D, Rineer J, Weiss JP, Safdieh J, Weiner J, Rotman M, Schwartz D. Clinical and biochemical outcomes of men undergoing radical prostatectomy or radiation therapy for localized prostate cancer. Radiat Oncol J 2015; 33:21-8. [PMID: 25874174 PMCID: PMC4394065 DOI: 10.3857/roj.2015.33.1.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/31/2014] [Accepted: 01/22/2015] [Indexed: 11/06/2022] Open
Abstract
Purpose We analyzed outcomes of patients with prostate cancer undergoing either radical retropubic prostatectomy (RRP) +/- salvage radiation or definitive radiation therapy (RT) +/- androgen deprivation. Materials and Methods From 2003-2010 there were 251 patients who underwent RRP and 469 patients who received RT (≥7,560 cGy) for prostate cancer. Kaplan-Meier analysis was performed with the log-rank test to compare biochemical control (bCR), distant metastatic-free survival (DMPFS), and prostate cancer-specific survival (PCSS) between the two groups. Results The median follow-up was 70 months and 61.3% of the men were African American. For low risk disease the 6-year bCR were 90.3% for RT and 85.6% for RRP (p = 0.23) and the 6-year post-salvage bCR were 90.3% vs. 90.9%, respectively (p = 0.84). For intermediate risk disease the 6-year bCR were 82.6% for RT and 59.7% for RRP (p < 0.001) and 82.6% vs. 74.0%, respectively, after including those salvaged with RT (p = 0.06). For high risk disease, the 6-year bCR were 67.4% for RT and 41.3% for RRP (p < 0.001) and after including those salvaged with RT was 67.4% vs. 43.1%, respectively (p < 0.001). However, there were no significant differences between the two groups in regards to DMPFS or PCSS. Conclusion Treatment approaches utilizing RRP +/- salvage radiation or RT +/- androgen deprivation yielded equivalent DMPFS and PCSS outcomes. Biochemical control rates, using their respective definitions, appeared equivalent or better in those who received treatment with RT.
Collapse
Affiliation(s)
- David Schreiber
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Justin Rineer
- University of Florida Health Cancer Center at Orlando Health, Orlando, FL, USA
| | - Jeffrey P Weiss
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Joseph Safdieh
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Joseph Weiner
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Marvin Rotman
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David Schwartz
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; SUNY Downstate Medical Center, Brooklyn, NY, USA
| |
Collapse
|
9
|
Shenouda G, Zhang Q, Ang KK, Machtay M, Parliament MB, Hershock D, Suntharalingam M, Lin A, Rotman M, Nabid A, Hong S, Shehata S, Cmelak AJ, Sultanem K, Le QT. Long-term results of radiation therapy oncology group 9903: a randomized phase 3 trial to assess the effect of erythropoietin on local-regional control in anemic patients treated with radiation therapy for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2015; 91:907-15. [PMID: 25670542 DOI: 10.1016/j.ijrobp.2014.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/27/2014] [Accepted: 12/08/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE This paper reports long-term results of RTOG 9903, to determine whether the addition of erythropoietin (EPO) would improve the outcomes of radiation therapy (RT) in mildly to moderately anemic patients with head and neck squamous cell carcinoma (HNSCCa). METHODS AND MATERIALS The trial included HNSCCa patients treated with definitive RT. Patients with stage III or IV disease received concomitant chemoradiation therapy or accelerated fractionation. Pretreatment hemoglobin levels were required to be between 9.0 and 13.5 g/dL (12.5 g/dL for females). EPO, 40,000 U, was administered weekly starting 7 to 10 days before RT was initiated in the RT + EPO arm. RESULTS A total of 141 of 148 enrolled patients were evaluable. The baseline median hemoglobin level was 12.1 g/dL. In the RT + EPO arm, the mean hemoglobin level at 4 weeks increased by 1.66 g/dL, whereas it decreased by 0.24 g/dL in the RT arm. With a median follow-up of 7.95 years (range: 1.66-10.08 years) for surviving patients and 3.33 years for all patients (range: 0.03-10.08 years), the 5-year estimate of local-regional failure was 46.2% versus 39.4% (P=.42), local-regional progression-free survival was 31.5% versus 37.6% (P=.20), and overall survival was 36.9% versus 38.2% (P=.54) for the RT + EPO and RT arms, respectively. Late toxicity was not different between the 2 arms. CONCLUSIONS This long-term analysis confirmed that despite the ability of EPO to raise hemoglobin levels in anemic patients with HNSCCa, it did not improve outcomes when added to RT. The possibility of a detrimental effect of EPO could not be ruled out.
Collapse
Affiliation(s)
| | - Qiang Zhang
- NRG Oncology Statistics and Data Management Center
| | - K Kian Ang
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Diane Hershock
- University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | | | - Alexander Lin
- University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Marvin Rotman
- Brooklyn Minority-based Community Clinical Oncology Program, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Abdenour Nabid
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke (Québec), Québec, Canada
| | | | - Sarwat Shehata
- Northeastern Ontario Regional Cancer Centre, Sudbury, Ontario, Canada
| | | | | | - Quynh-Thu Le
- Stanford University Medical Center, Stanford, California
| |
Collapse
|
10
|
Safdieh JJ, Schwartz D, Weiner J, Weiss JP, Rineer J, Madeb I, Rotman M, Schreiber D. Long-term tolerance and outcomes for dose escalation in early salvage post-prostatectomy radiation therapy. Radiat Oncol J 2014; 32:179-86. [PMID: 25324990 PMCID: PMC4194301 DOI: 10.3857/roj.2014.32.3.179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/05/2014] [Accepted: 08/21/2014] [Indexed: 11/04/2022] Open
Abstract
Purpose To study the long-term outcomes and tolerance in our patients who received dose escalated radiotherapy in the early salvage post-prostatectomy setting. Materials and Methods The medical records of 54 consecutive patients who underwent radical prostatectomy subsequently followed by salvage radiation therapy (SRT) to the prostate bed between 2003-2010 were analyzed. Patients included were required to have a pre-radiation prostate specific antigen level (PSA) of 2 ng/mL or less. The median SRT dose was 70.2 Gy. Biochemical failure after salvage radiation was defined as a PSA level >0.2 ng/mL. Biochemical control and survival endpoints were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox regression analysis were used to identify the potential impact of confounding factors on outcomes. Results The median pre-SRT PSA was 0.45 ng/mL and the median follow-up time was 71 months. The 4- and 7-year actuarial biochemical control rates were 75.7% and 63.2%, respectively. The actuarial 4- and 7-year distant metastasis-free survival was 93.7% and 87.0%, respectively, and the actuarial 7-year prostate cancer specific survival was 94.9%. Grade 3 late genitourinary toxicity developed in 14 patients (25.9%), while grade 4 late genitourinary toxicity developed in 2 patients (3.7%). Grade 3 late gastrointestinal toxicity developed in 1 patient (1.9%), and grade 4 late gastrointestinal toxicity developed in 1 patient (1.9%). Conclusion In this series with long-term follow-up, early SRT provided outcomes and toxicity profiles similar to those reported from the three major randomized trials studying adjuvant radiation therapy.
Collapse
Affiliation(s)
- Joseph J Safdieh
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David Schwartz
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Joseph Weiner
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Jeffrey P Weiss
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Justin Rineer
- University of Florida Health Cancer Center, Orlando, FL, USA
| | - Isaac Madeb
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Marvin Rotman
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David Schreiber
- Department of Veteran Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. ; Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| |
Collapse
|
11
|
Schreiber D, Rineer J, Safdieh J, Weiner J, Weiss J, Rotman M, Schwartz D. Comparative Effectiveness of Radical Prostatectomy Versus Dose Escalated Radiation Therapy in a Predominantly African American Population. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
12
|
Schreiber D, Rineer J, Surapaneni A, Navo E, Agarwal M, Nwokedi E, Rotman M, Schwartz D. Dose-escalated radiation therapy with and without short-course androgen deprivation for intermediate-risk prostate cancer. Anticancer Res 2014; 34:4189-4193. [PMID: 25075045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To investigate outcomes in intermediate-risk (IR) prostate cancer patients receiving dose-escalated external beam radiation therapy (RT) with or without short-course androgen deprivation (ADT). PATIENTS AND METHODS This study comprised of 203 patients with IR prostate cancer who were treated at a single institution to a dose of 7,560 cGy or more between 2003-2010. Of these, 62 (30.5%) patients received ADT. Biochemical recurrence, distant metastatic-free survival, prostate cancer-specific survival, and overall survival were analyzed using the Kaplan-Meier method. RESULTS The median follow-up was 62 months and the median duration of ADT was 6 months. The 6-year biochemical control was 89.2% for those receiving RT plus ADT versus 76.7% in those receiving RT alone (p=0.02). There were no differences between the two groups regarding distant metastatic-free survival, prostate cancer-specific survival, and overall survival (respective p-values of 0.91, 0.50, 0.67). CONCLUSION Dose-escalated RT and short-course ADT results in improved biochemical outcomes for IR prostate cancer.
Collapse
Affiliation(s)
- David Schreiber
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, NY, U.S.A. Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, U.S.A.
| | - Justin Rineer
- Department of Radiation Oncology, UF Orlando Health Center, Orlando, FL, U.S.A
| | - Aparna Surapaneni
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, NY, U.S.A. Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, U.S.A
| | - Elliot Navo
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, NY, U.S.A. Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, U.S.A
| | - Manuj Agarwal
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, NY, U.S.A. Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, U.S.A
| | - Emmanuel Nwokedi
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, NY, U.S.A
| | - Marvin Rotman
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, NY, U.S.A. Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, U.S.A
| | - David Schwartz
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, New York, NY, U.S.A. Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, U.S.A
| |
Collapse
|
13
|
Harari PM, Harris J, Kies MS, Myers JN, Jordan RC, Gillison ML, Foote RL, Machtay M, Rotman M, Khuntia D, Straube W, Zhang Q, Ang K. Postoperative chemoradiotherapy and cetuximab for high-risk squamous cell carcinoma of the head and neck: Radiation Therapy Oncology Group RTOG-0234. J Clin Oncol 2014; 32:2486-95. [PMID: 25002723 DOI: 10.1200/jco.2013.53.9163] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To report results of a randomized phase II trial (Radiation Therapy Oncology Group RTOG-0234) examining concurrent chemoradiotherapy and cetuximab in the postoperative treatment of patients with squamous cell carcinoma of the head and neck (SCCHN) with high-risk pathologic features. PATIENTS AND METHODS Eligibility required pathologic stage III to IV SCCHN with gross total resection showing positive margins and/or extracapsular nodal extension and/or two or more nodal metastases. Patients were randomly assigned to 60 Gy radiation with cetuximab once per week plus either cisplatin 30 mg/m(2) or docetaxel 15 mg/m(2) once per week. RESULTS Between April 2004 and December 2006, 238 patients were enrolled. With a median follow-up of 4.4 years, 2-year overall survival (OS) was 69% for the cisplatin arm and 79% for the docetaxel arm; 2-year disease-free survival (DFS) was 57% and 66%, respectively. Patients with p16-positive oropharynx tumors showed markedly improved survival outcome relative to patients with p16-negative oropharynx tumors. Grade 3 to 4 myelosuppression was observed in 28% of patients in the cisplatin arm and 14% in the docetaxel arm; mucositis was observed in 56% and 54%, respectively. DFS in this study was compared with that in the chemoradiotherapy arm of the RTOG-9501 trial (Phase III Intergroup Trial of Surgery Followed by Radiotherapy Versus Radiochemotherapy for Resectable High Risk Squamous Cell Carcinoma of the Head and Neck), which had a hazard ratio of 0.76 for the cisplatin arm versus control (P = .05) and 0.69 for the docetaxel arm versus control (P = .01), reflecting absolute improvement in 2-year DFS of 2.5% and 11.1%, respectively. CONCLUSION The delivery of postoperative chemoradiotherapy and cetuximab to patients with SCCHN is feasible and tolerated with predictable toxicity. The docetaxel regimen shows favorable outcome with improved DFS and OS relative to historical controls and has commenced formal testing in a phase II/III trial.
Collapse
Affiliation(s)
- Paul M Harari
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO.
| | - Jonathan Harris
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO
| | - Merrill S Kies
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO
| | - Jeffrey N Myers
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO
| | - Richard C Jordan
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO
| | - Maura L Gillison
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO
| | - Robert L Foote
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO
| | - Mitchell Machtay
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO
| | - Marvin Rotman
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO
| | - Deepak Khuntia
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO
| | - William Straube
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO
| | - Qiang Zhang
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO
| | - Kian Ang
- Paul M. Harari, University of Wisconsin Hospital, Madison, WI; Jonathan Harris and Qiang Zhang, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Merrill S. Kies, Jeffrey N. Myers, and Kian Ang, MD Anderson Cancer Center, Houston, TX; Richard C. Jordan, University of California San Francisco, San Francisco; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Maura L. Gillison, The Ohio State University, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Robert L. Foote, Mayo Clinic, Rochester, MN; Marvin Rotman, State University of New York Downstate Medical Center, Brooklyn, NY; and William Straube, Washington University, St. Louis, MO
| |
Collapse
|
14
|
Olsheski M, Schwartz D, Rineer J, Wortham A, Sura S, Sugiyama G, Rotman M, Schreiber D. A population-based comparison of overall and disease-specific survival following local excision or abdominoperineal resection for stage I rectal adenocarcinoma. J Gastrointest Cancer 2014; 44:305-12. [PMID: 23564262 DOI: 10.1007/s12029-013-9493-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The use of local excision (LE) for early stage rectal adenocarcinoma is increasing due to the associated morbidity of radical resection. To determine if survival in stage I rectal cancer differs following LE or abdominoperineal resection (APR), we analyzed the Surveillance, Epidemiology, and End Results Database. MATERIAL AND METHODS We selected patients diagnosed between 1988 and 2002 with T1-2N0M0 rectal adenocarcinoma measuring ≤4 cm who underwent either local excision with (LE + RT) or without adjuvant radiation (LE alone) or APR alone. Overall survival (OS) and disease-specific survival (DSS) curves were calculated using the Kaplan-Meier method. Univariate and multivariate Cox regression was also performed to determine the effect of covariates on OS and DSS. RESULTS A total of 2,391 patients were identified including 981 (41 %) treated with APR, 1,018 (43 %) treated with LE alone, and 392 (16 %) treated with LE + RT. With a median follow-up of 69 months, there was no difference in OS or DSS seen between the three groups (p > 0.05 for all comparisons). When stratifying by T-stage, there was a significant difference in overall survival between LE alone and APR for T2 disease. However, there was no difference in DSS between these two subgroups. There were no other significant survival differences between all comparable subgroups. CONCLUSIONS In this large population-based study, there was no difference in long-term DSS between patients who underwent an APR compared to selected patients who underwent LE with or without adjuvant radiation. Although these data further reinforce the promising data regarding the selected use of LE, further prospective studies are needed to further elucidate the role of LE in this setting.
Collapse
Affiliation(s)
- Michelle Olsheski
- Department of Veterans Affairs, New York Harbor Healthcare System, New York, NY 11209, USA.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Schwartz D, Nwokedi E, Rineer J, Rotman M, Schreiber D, Surapaneni A. Radiation therapy for clinically localized prostate cancer: Long-term results of 469 patients from a single institution in the era of dose escalation. J Cancer Res Ther 2014; 10:951-6. [DOI: 10.4103/0973-1482.138096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
16
|
Agarwal M, Schwartz D, Weiss J, Chen SC, Chhabra A, Rotman M, Schreiber D. Concordance Between Prostate Needle Biopsy and Surgical Histopathology in a Primarily African-American Population. Int J Surg Pathol 2013; 22:414-9. [DOI: 10.1177/1066896913513834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. Prior studies have revealed that the concordance between biopsy and surgical specimens has been improving over time. However, to date, this has not been analyzed in an African American population, for whom data have often shown more aggressive prostate cancer than for other races. Methods. We analyzed 250 patients who were operated on at the NY Harbor Department of Veterans Affairs for localized prostate cancer between 2003 and 2010. The clinical biopsy scores were compared with the pathological biopsy scores. We compared the concordance using the κ coefficient. Univariate and multivariate logistic regressions were used to identify predictors for poor concordance. Results. This population consisted of 59.6% African Americans, 32% Caucasians, and 8.4% Hispanics. Overall, there was a 50% exact concordance between the biopsy and surgical specimens. The κ was 0.33, indicating fair agreement. Patients with a Gleason score of 6 were found to have an exact concordance 66% of the time, and those with a score of Gleason 7 (3 + 4) had an exact concordance 50% of the time. On univariate and multivariate analyses, only an increasing prostate-specific antigen was associated with reduced concordance. Race was not a significant predictor. Conclusions. These data are in line with prior studies of concordance. Despite being a population with more aggressive prostate cancer, there does not appear to be an increase in the risk of discordance in African American men.
Collapse
Affiliation(s)
- Manuj Agarwal
- New York Harbor Healthcare System, Brooklyn, NY, USA
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David Schwartz
- New York Harbor Healthcare System, Brooklyn, NY, USA
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Jeffrey Weiss
- New York Harbor Healthcare System, Brooklyn, NY, USA
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Shan-Chin Chen
- New York Harbor Healthcare System, Brooklyn, NY, USA
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Arpit Chhabra
- New York Harbor Healthcare System, Brooklyn, NY, USA
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Marvin Rotman
- New York Harbor Healthcare System, Brooklyn, NY, USA
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David Schreiber
- New York Harbor Healthcare System, Brooklyn, NY, USA
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| |
Collapse
|
17
|
Agarwal M, Rotman M, Schwartz D, Schreiber D. Concordance of Gleason Score on Biopsy and Prostatectomy in a Contemporary Cohort of U.S. Veterans Undergoing Radical Prostatectomy. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
18
|
Surapaneni A, Schwartz D, Nwokedi E, Chabra A, Choi K, Rotman M, Schreiber D. Radiation Therapy for Clinically Localized Prostate Cancer: Long-term Results From the NY Harbor Department of Veteran's Administration in the Era of Dose Escalation. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
19
|
Nichols R, George A, Bahary J, Zeitzer K, Souhami L, Leibenhaut M, Rotman M, Gore E, Balogh A, Jones C. Serum Testosterone Changes in Patients Treated With Radiation Therapy Alone for Prostate Cancer on RTOG 9408. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
20
|
Kachnic LA, Winter K, Myerson RJ, Goodyear MD, Willins J, Esthappan J, Haddock MG, Rotman M, Parikh PJ, Safran H, Willett CG. RTOG 0529: a phase 2 evaluation of dose-painted intensity modulated radiation therapy in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. Int J Radiat Oncol Biol Phys 2012; 86:27-33. [PMID: 23154075 DOI: 10.1016/j.ijrobp.2012.09.023] [Citation(s) in RCA: 424] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/14/2012] [Accepted: 09/18/2012] [Indexed: 12/15/2022]
Abstract
PURPOSE A multi-institutional phase 2 trial assessed the utility of dose-painted intensity modulated radiation therapy (DP-IMRT) in reducing grade 2+ combined acute gastrointestinal and genitourinary adverse events (AEs) of 5-fluorouracil (5FU) and mitomycin-C (MMC) chemoradiation for anal cancer by at least 15% compared with the conventional radiation/5FU/MMC arm from RTOG 9811. METHODS AND MATERIALS T2-4N0-3M0 anal cancer patients received 5FU and MMC on days 1 and 29 of DP-IMRT, prescribed per stage: T2N0, 42 Gy elective nodal and 50.4 Gy anal tumor planning target volumes (PTVs) in 28 fractions; T3-4N0-3, 45 Gy elective nodal, 50.4 Gy ≤ 3 cm or 54 Gy >3 cm metastatic nodal and 54 Gy anal tumor PTVs in 30 fractions. The primary endpoint is described above. Planned secondary endpoints assessed all AEs and the investigator's ability to perform DP-IMRT. RESULTS Of 63 accrued patients, 52 were evaluable. Tumor stage included 54% II, 25% IIIA, and 21% IIIB. In primary endpoint analysis, 77% experienced grade 2+ gastrointestinal/genitourinary acute AEs (9811 77%). There was, however, a significant reduction in acute grade 2+ hematologic, 73% (9811 85%, P=.032), grade 3+ gastrointestinal, 21% (9811 36%, P=.0082), and grade 3+ dermatologic AEs 23% (9811 49%, P<.0001) with DP-IMRT. On initial pretreatment review, 81% required DP-IMRT replanning, and final review revealed only 3 cases with normal tissue major deviations. CONCLUSIONS Although the primary endpoint was not met, DP-IMRT was associated with significant sparing of acute grade 2+ hematologic and grade 3+ dermatologic and gastrointestinal toxicity. Although DP-IMRT proved feasible, the high pretreatment planning revision rate emphasizes the importance of real-time radiation quality assurance for IMRT trials.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anal Canal
- Analysis of Variance
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Anus Neoplasms/diagnostic imaging
- Anus Neoplasms/pathology
- Anus Neoplasms/therapy
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/therapy
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/therapy
- Chemoradiotherapy/adverse effects
- Chemoradiotherapy/methods
- Dose Fractionation, Radiation
- Drug Administration Schedule
- Female
- Fluorouracil/administration & dosage
- Fluorouracil/adverse effects
- Gastrointestinal Tract/radiation effects
- Humans
- Male
- Middle Aged
- Mitomycin/administration & dosage
- Mitomycin/adverse effects
- Neoplasm Staging
- Radiation Injuries/prevention & control
- Radiography
- Radiotherapy Planning, Computer-Assisted/standards
- Radiotherapy, Intensity-Modulated/adverse effects
- Radiotherapy, Intensity-Modulated/methods
- Urogenital System/radiation effects
Collapse
Affiliation(s)
- Lisa A Kachnic
- Department of Radiation Oncology, Boston University Medical Center, Boston, Massachusetts 02118, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Surapaneni A, Sura S, Rineer J, Schwartz D, Rotman M, Schreiber D. Effect of Radiation on Breast Cancer Specific Survival for Elderly Women With Early Stage (T1N0 ER+) Breast Cancer: Review of the SEER Database. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
22
|
Sroufe RL, Schwartz D, Rineer J, Choi K, Rotman M, Schreiber D. A population-based study of the impact of post-mastectomy radiation on survival for male breast cancer. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13566-012-0062-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Cooper JS, Zhang Q, Pajak TF, Forastiere AA, Jacobs J, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Lustig R, Ensley JF, Thorstad W, Schultz CJ, Yom SS, Ang KK. Long-term follow-up of the RTOG 9501/intergroup phase III trial: postoperative concurrent radiation therapy and chemotherapy in high-risk squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2012; 84:1198-205. [PMID: 22749632 DOI: 10.1016/j.ijrobp.2012.05.008] [Citation(s) in RCA: 320] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 04/27/2012] [Accepted: 05/03/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE Previous analysis of this Intergroup trial demonstrated that with a median follow-up among surviving patients of 45.9 months, the concurrent postoperative administration of cisplatin and radiation therapy improved local-regional control and disease-free survival of patients who had high-risk resectable head-and-neck carcinomas. With a minimum of 10 years of follow-up potentially now available for all patients, these results are updated here to examine long-term outcomes. METHODS AND MATERIALS A total of 410 analyzable patients who had high-risk resected head-and-neck cancers were prospectively randomized to receive either radiation therapy (RT: 60 Gy in 6 weeks) or identical RT plus cisplatin, 100 mg/m(2)i.v. on days 1, 22, and 43 (RT + CT). RESULTS At 10 years, the local-regional failure rates were 28.8% vs 22.3% (P=.10), disease-free survival was 19.1% vs 20.1% (P=.25), and overall survival was 27.0% vs 29.1% (P=.31) for patients treated by RT vs RT + CT, respectively. In the unplanned subset analysis limited to patients who had microscopically involved resection margins and/or extracapsular spread of disease, local-regional failure occurred in 33.1% vs 21.0% (P=.02), disease-free survival was 12.3% vs 18.4% (P=.05), and overall survival was 19.6% vs 27.1% (P=.07), respectively. CONCLUSION At a median follow-up of 9.4 years for surviving patients, no significant differences in outcome were observed in the analysis of all randomized eligible patients. However, analysis of the subgroup of patients who had either microscopically involved resection margins and/or extracapsular spread of disease showed improved local-regional control and disease-free survival with concurrent administration of chemotherapy. The remaining subgroup of patients who were enrolled only because they had tumor in 2 or more lymph nodes did not benefit from the addition of CT to RT.
Collapse
Affiliation(s)
- Jay S Cooper
- Maimonides Cancer Center, New York, New York, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Roach M, Yan Y, Lawton CA, Hsu ICJ, Lustig RA, Jones CU, Rotman M, Zeitzer KL, Werner-Wasik M, Kim H, Thomas CR, Shipley WU, Sandler HM. Radiation Therapy Oncology Group (RTOG) 9413: Randomized trial comparing whole pelvic radiotherapy (WPRT) to prostate only (PORT) and neoadjuvant hormone therapy (NHT) to adjuvant hormone therapy (AHT). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
96 Background: RTOG 9413 demonstrated that NHT+WPRT improved progression-free survival (PFS) compared to NHT+PORT, WPRT+AHT and PORT+AHT. We update primary and secondary endpoints (SE): biochemical failure (BF), time to metastasis (Mets), prostate specific survival (PSS) and overall survival (OS). Methods: RTOG 9413 opened on April 1, 1995, and closed on June 1, 1999, with 1275 eligible pts who were required to have a risk of lymph node (LN) involvement >15% but LN-positive pts were ineligible. They were stratified by T Stage, GS (<7 vs 7-10) and PSA (>30 vs < 30ng/ml) and randomized to PORT +/- WPRT to 70 Gy and NHT or AHT. Hormonal therapy (HT) consisted of flutamide, and leuprolide or goserelin, monthly x 4 mos, beginning 2 mos before RT and continued until RT is completed (NHT) or beginning at the completion of RT (AHT). For this analysis PFS was defined as the first occurrence of local/regional or LN progression, Mets, BF (PSA nadir+2ng/mL), or death from any cause. PSS is defined as a death due to prostate cancer, treatment toxicity or unknown causes with local progression, Mets or BF. Results: For the entire cohort WPRT or NHT did not appear to improve any endpoint compared with PORT or AHT, (although there was a trend for improvement in regional failure for WPRT vs PORT, (p=0.07)). However, there were complex sequence/volume dependent interactions between HT and RT and statistically significant differences between the 4 arms in PFS (p=0.03). There was a trend for NHT+WPRT to improved PFS compared to NHT+PO (p=0.07) and WPRT+AHT (p=0.04). NHT+WPRT was associated with an increased risk of late GI toxicity, 5% compared to 0.6%, 2% and 2% for NHT+PORT, WPRT+AHT and PORT+AHT (p<0.001) but not in GU late toxicity. Conclusions: The failure to improve SE or definitively impact PFS may reflect sample size, pt selection, and inadequate RT doses. RTOG 0924 will test the hypotheses that modern techniques and doses will improve OS without increasing late toxicity.
Collapse
Affiliation(s)
- Mack Roach
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Yan Yan
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Colleen Anne Lawton
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - I-Chow Joe Hsu
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Robert A. Lustig
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Christopher U. Jones
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Marvin Rotman
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Kenneth Lee Zeitzer
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Maria Werner-Wasik
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Harold Kim
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Charles R. Thomas
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - William U. Shipley
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| | - Howard Mark Sandler
- University of California, San Francisco, San Francisco, CA; Radiation Therapy Oncology Group, Philadelphia, PA; Medical College of Wisconsin, Milwaukee, WI; Hospital of the University of Pennsylvania, Philadelphia, PA; Radiological Associates of Sacramento, Sacramento, CA; SUNY Health Science Center, Brooklyn, NY; Albert Einstein Medical Center, Philadelphia, PA; Thomas Jefferson University Hospital, Philadelphia, PA; Karmanos Cancer Institute, Wayne State University, Detroit, MI; Oregon Health and
| |
Collapse
|
25
|
Efstathiou JA, Paulus R, Smith MR, Jones CU, Leibenhaut MH, Husain SM, Rotman M, Souhami L, Sandler HM, Shipley WU. Cardiovascular mortality following short-term androgen deprivation in clinically localized prostate cancer: An analysis of RTOG 94-08. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18 Background: Androgen deprivation therapy (ADT) is associated with greater risk of diabetes and coronary heart disease in men with prostate cancer but there is significant controversy surrounding its potential impact on cardiovascular mortality especially among men with lower rates of cancer-specific death. We assessed the relationship between ADT and mortality in a large randomized trial of men treated with or without short-course ADT and radiation therapy (RT) for clinically-localized prostate cancer. Methods: Between 1994-2001, 1979 eligible men (median age 71) with clinically-localized (T1-2, PSA<20) prostate cancer were enrolled on a phase III trial (RTOG 94-08) and randomized to RT and 4 months of neoadjuvant/concurrent ADT or RT alone. Fine-Gray proportional hazards model was used to evaluate the relationship between treatment arm and mortality (disease-specific and cardiovascular). Covariates included PSA, Gleason score, T-stage, age, race, weight, prevalent cardiovascular disease (CVD), diabetes (DM), and hypertension. Results: After a median follow-up of 8.2 years, use of ADT improved overall and disease-specific survival but there was no ADT-related increase in cardiovascular mortality or non-prostate cancer death. There were a total of 191 cardiovascular-related deaths. At 10-years, cardiovascular mortality for men treated with RT+ADT was 9.8% vs 10.7% for men treated with RT alone. In multivariate analyses, treatment arm was not significantly associated with an increased risk of cardiovascular mortality [adjusted hazard ratio (HR)=0.93, 95% confidence interval (CI) 0.69-1.26, p=0.64]. Traditional cardiac risk factors, including prevalent CVD and DM, were significantly associated with greater cardiovascular mortality. Results were similar when limiting analyses to patient subsets at high risk for cardiovascular mortality and at low risk for disease-specific mortality. Conclusions: Use of short-course ADT improves overall and disease-specific survival but does not appear to increase cardiovascular mortality in men with clinically-localized prostate cancer. Supported by RTOG grant U10 CA21661 and CCOP grant U10 CA37422 from NCI.
Collapse
Affiliation(s)
- Jason Alexander Efstathiou
- Massachusetts General Hospital, Boston, MA; RTOG, Philadelphia, PA; Massachusetts General Hospital Cancer Center, Boston, MA; Radiological Associates of Sacramento, Sacramento, CA; Baker Cancer Centre, Calgary, AB, Canada; SUNY Health Science Center, Brooklyn, NY; McGill University, Montreal, QC, Canada; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Rebecca Paulus
- Massachusetts General Hospital, Boston, MA; RTOG, Philadelphia, PA; Massachusetts General Hospital Cancer Center, Boston, MA; Radiological Associates of Sacramento, Sacramento, CA; Baker Cancer Centre, Calgary, AB, Canada; SUNY Health Science Center, Brooklyn, NY; McGill University, Montreal, QC, Canada; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Matthew R. Smith
- Massachusetts General Hospital, Boston, MA; RTOG, Philadelphia, PA; Massachusetts General Hospital Cancer Center, Boston, MA; Radiological Associates of Sacramento, Sacramento, CA; Baker Cancer Centre, Calgary, AB, Canada; SUNY Health Science Center, Brooklyn, NY; McGill University, Montreal, QC, Canada; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Christopher U. Jones
- Massachusetts General Hospital, Boston, MA; RTOG, Philadelphia, PA; Massachusetts General Hospital Cancer Center, Boston, MA; Radiological Associates of Sacramento, Sacramento, CA; Baker Cancer Centre, Calgary, AB, Canada; SUNY Health Science Center, Brooklyn, NY; McGill University, Montreal, QC, Canada; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark H. Leibenhaut
- Massachusetts General Hospital, Boston, MA; RTOG, Philadelphia, PA; Massachusetts General Hospital Cancer Center, Boston, MA; Radiological Associates of Sacramento, Sacramento, CA; Baker Cancer Centre, Calgary, AB, Canada; SUNY Health Science Center, Brooklyn, NY; McGill University, Montreal, QC, Canada; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Siraj M. Husain
- Massachusetts General Hospital, Boston, MA; RTOG, Philadelphia, PA; Massachusetts General Hospital Cancer Center, Boston, MA; Radiological Associates of Sacramento, Sacramento, CA; Baker Cancer Centre, Calgary, AB, Canada; SUNY Health Science Center, Brooklyn, NY; McGill University, Montreal, QC, Canada; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Marvin Rotman
- Massachusetts General Hospital, Boston, MA; RTOG, Philadelphia, PA; Massachusetts General Hospital Cancer Center, Boston, MA; Radiological Associates of Sacramento, Sacramento, CA; Baker Cancer Centre, Calgary, AB, Canada; SUNY Health Science Center, Brooklyn, NY; McGill University, Montreal, QC, Canada; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Luis Souhami
- Massachusetts General Hospital, Boston, MA; RTOG, Philadelphia, PA; Massachusetts General Hospital Cancer Center, Boston, MA; Radiological Associates of Sacramento, Sacramento, CA; Baker Cancer Centre, Calgary, AB, Canada; SUNY Health Science Center, Brooklyn, NY; McGill University, Montreal, QC, Canada; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Howard Mark Sandler
- Massachusetts General Hospital, Boston, MA; RTOG, Philadelphia, PA; Massachusetts General Hospital Cancer Center, Boston, MA; Radiological Associates of Sacramento, Sacramento, CA; Baker Cancer Centre, Calgary, AB, Canada; SUNY Health Science Center, Brooklyn, NY; McGill University, Montreal, QC, Canada; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - William U. Shipley
- Massachusetts General Hospital, Boston, MA; RTOG, Philadelphia, PA; Massachusetts General Hospital Cancer Center, Boston, MA; Radiological Associates of Sacramento, Sacramento, CA; Baker Cancer Centre, Calgary, AB, Canada; SUNY Health Science Center, Brooklyn, NY; McGill University, Montreal, QC, Canada; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| |
Collapse
|
26
|
Kim A, Schreiber D, Rineer J, Choi K, Rotman M. Impact of Adjuvant External-Beam Radiation Therapy in Early-Stage Uterine Papillary Serous and Clear Cell Carcinoma. Int J Radiat Oncol Biol Phys 2011; 81:e639-44. [DOI: 10.1016/j.ijrobp.2011.01.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Revised: 01/13/2011] [Accepted: 01/26/2011] [Indexed: 10/18/2022]
|
27
|
Surapaneni A, Katsoulakis E, Boo D, Sroufe R, Sura S, Olsheski M, Han P, Choi K, Rotman M, Schreiber D. Effect of Radiation on Survival for Patients with Uterine Leiomyosarcoma: Review of the SEER Database. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
28
|
Schreiber D, Rineer J, Weiss J, Olsheski M, Sura S, Sroufe R, Rotman M, Schwartz D. Characterization and Outcomes of Small Cell Carcinoma of the Bladder using the Surveillance, Epidemiology and End Results Database. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
29
|
Portelance L, Moughan J, Jhingran A, Miller B, Salehpour M, D'Souza D, Haddock M, Rotman M, Gaffney D. A Phase II Multi-institutional Study of Postoperative Pelvic Intensity Modulated Radiation Therapy (IMRT) with Weekly Cisplatin in Patients with Cervical Carcinoma: Two Year Efficacy Results of the RTOG 0418. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
30
|
Katsoulakis E, Surapaneni A, Boo D, Sroufe R, Olsheski M, Sura S, Chen W, Choi K, Rotman M, Schreiber D. Radiation Therapy And Vaginal Squamous Cell Carcinoma: An Analysis Of The Surveillance, Epidemiology And End-results (SEER) Registry. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
31
|
Efstathiou J, Paulus R, Smith M, Jones C, Leibenhaut M, Husain S, Rotman M, Souhami L, Sandler H, Shipley W. Cardiovascular Mortality following Short-term Androgen Deprivation in Clinically Localized Prostate Cancer: An Analysis of RTOG 94-08. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
32
|
Jones CU, Hunt D, McGowan DG, Amin MB, Chetner MP, Bruner DW, Leibenhaut MH, Husain SM, Rotman M, Souhami L, Sandler HM, Shipley WU. Radiotherapy and short-term androgen deprivation for localized prostate cancer. N Engl J Med 2011; 365:107-18. [PMID: 21751904 DOI: 10.1056/nejmoa1012348] [Citation(s) in RCA: 504] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is not known whether short-term androgen-deprivation therapy (ADT) before and during radiotherapy improves cancer control and overall survival among patients with early, localized prostate adenocarcinoma. METHODS From 1994 through 2001, we randomly assigned 1979 eligible patients with stage T1b, T1c, T2a, or T2b prostate adenocarcinoma and a prostate-specific antigen (PSA) level of 20 ng per milliliter or less to radiotherapy alone (992 patients) or radiotherapy with 4 months of total androgen suppression starting 2 months before radiotherapy (radiotherapy plus short-term ADT, 987 patients). The primary end point was overall survival. Secondary end points included disease-specific mortality, distant metastases, biochemical failure (an increasing level of PSA), and the rate of positive findings on repeat prostate biopsy at 2 years. RESULTS The median follow-up period was 9.1 years. The 10-year rate of overall survival was 62% among patients receiving radiotherapy plus short-term ADT (the combined-therapy group), as compared with 57% among patients receiving radiotherapy alone (hazard ratio for death with radiotherapy alone, 1.17; P=0.03). The addition of short-term ADT was associated with a decrease in the 10-year disease-specific mortality from 8% to 4% (hazard ratio for radiotherapy alone, 1.87; P=0.001). Biochemical failure, distant metastases, and the rate of positive findings on repeat prostate biopsy at 2 years were significantly improved with radiotherapy plus short-term ADT. Acute and late radiation-induced toxic effects were similar in the two groups. The incidence of grade 3 or higher hormone-related toxic effects was less than 5%. Reanalysis according to risk showed reductions in overall and disease-specific mortality primarily among intermediate-risk patients, with no significant reductions among low-risk patients. CONCLUSIONS Among patients with stage T1b, T1c, T2a, or T2b prostate adenocarcinoma and a PSA level of 20 ng per milliliter or less, the use of short-term ADT for 4 months before and during radiotherapy was associated with significantly decreased disease-specific mortality and increased overall survival. According to post hoc risk analysis, the benefit was mainly seen in intermediate-risk, but not low-risk, men. (Funded by the National Cancer Institute; RTOG 94-08 ClinicalTrials.gov number, NCT00002597.).
Collapse
|
33
|
Watkins Bruner D, James JL, Bryan CJ, Pisansky TM, Rotman M, Corbett T, Speight J, Byhardt R, Sandler H, Bentzen S, Kachnic L, Berk L. Randomized, double-blinded, placebo-controlled crossover trial of treating erectile dysfunction with sildenafil after radiotherapy and short-term androgen deprivation therapy: results of RTOG 0215. J Sex Med 2011; 8:1228-38. [PMID: 21235716 PMCID: PMC3557497 DOI: 10.1111/j.1743-6109.2010.02164.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Erectile dysfunction (ED) may be the most commonly observed adverse event (AE) associated with the combination of radiation therapy (RT) and androgen deprivation therapy (ADT). A significant number of men are trying phosphodiesterase type 5 inhibitors (PDE5s) such as sildenafil to treat ED, yet sildenafil studies to date shed little light on the response to ED after ADT. AIM The purpose of this trial was to evaluate sildenafil in the treatment of ED in prostate cancer patients previously treated with external beam RT and neoadjuvant and concurrent ADT. METHODS In this randomized, double-blinded crossover trial, eligible patients received RT/ADT for intermediate risk prostate cancer and currently had ED as defined by the International Index of Erectile Function (IIEF). Patients were randomized to 12 weeks of sildenafil or placebo followed by 1 week of no treatment then 12 weeks of the alternative. Treatment differences were evaluated using a marginal model for binary crossover data. MAIN OUTCOME MEASURES The primary end point was improved erectile function, as measured by the IIEF. RESULTS The study accrued 115 patients and 61 (55%) completed all three IIEF assessments. Sildenafil effect was significant (P = 0.009) with a difference in probabilities of erectile response of 0.17 (95% confidence interval: 0.06, 0.29), and 0.21 (0.06, 0.38) for patients receiving ≤ 120 days of ADT. However, as few as 21% of patients had a treatment-specific response, only improving during sildenafil but not during the placebo phase. CONCLUSIONS This is the first controlled trial to suggest a positive sildenafil response for ED treatment in patients previously treated with RT/ADT, however, only a minority of patients responded to treatment. ADT duration may be associated with response and requires further study. The overall low response rate suggests the need for study of additional or preventative strategies for ED after RT/ADT for prostate cancer.
Collapse
|
34
|
Kachnic LA, Winter KA, Myerson RJ, Goodyear MD, Willins J, Esthappan J, Haddock MG, Rotman M, Parikh PJ, Willett CG. Two-year outcomes of RTOG 0529: A phase II evaluation of dose-painted IMRT in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.368] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
368 Background: 5-Fluorouracil (5FU) and mitomycin-C (MMC) chemoradiation for anal cancer is associated with high rates of acute morbidity. We have previously shown that dose-painted IMRT (DP-IMRT) significantly reduces grade 3+ GI and dermatologic acute toxicity, as compared to the RTOG 9811 5FU/MMC arm, which used non-conformal radiation techniques. We now report on the two-year outcomes of this DP-IMRT approach. Methods: T2-4N0-3M0 anal canal cancers received 5FU (1,000 mg/m2/day 96 hour infusion) and MMC (10 mg/m2 bolus) days 1 and 29 of DP-IMRT prescribed as follows - T2N0: 42 Gy elective nodal and 50.4 Gy anal tumor planning target volumes (PTVs), 28 fractions; T3-4N0-3: 45 Gy elective nodal, 50.4 Gy ≤ 3 cm and 54 Gy > 3 cm metastatic nodal and 54 Gy anal tumor PTVs, 30 fractions. The following two-year outcomes were assessed: local-regional (LRF) and colostomy failures (CF) using the cumulative incidence method, and disease-free (DFS), overall (OS) and colostomy-free survivals (CFS) using the Kaplan-Meier method. Results: Of 63 accrued patients, 52 were analyzable. Median age was 58 years; 81% female; 54% stage II; 25% IIIA; 21% IIIB. Median follow-up was 23.2 months (0.2-33). Two-year LRF, CF, DFS and 95% confidence intervals are 20% (9%, 31%), 8% (0.4%, 15%) and 77% (62%, 86%), respectively. The causes of death for the 7 patients that died are: anal cancer in 5, morbidity in one and second primary outside the radiation field in one. Two-year comparison data from the RTOG 9811 5FU/MMC arm are shown in the table below. Conclusions: DP-IMRT with 5FU/MMC for the treatment of anal canal cancer yields similar two-year outcomes as the RTOG 9811 conventional radiation, 5FU/MMC arm. Because of the associated acute toxicity sparing, DP-IMRT will be used as the platform, and may allow for radiation dose escalation, in future RTOG anal canal trials. Supported by RTOG U10 CA21661, CCOP U10 CA3742 and ATC U24 CA 81647 NCI grants. [Table: see text] No significant financial relationships to disclose.
Collapse
Affiliation(s)
- L. A. Kachnic
- Boston Medical Center, Boston, MA; ACR/RTOG, Philadelphia, PA; Washington University School of Medicine, St. Louis, MO; Dalhousie University, Halifax, NS, Canada; Mayo Clinic, Rochester, MN; SUNY Health Science Center, Brooklyn, NY; Duke University Medical Center, Durham, NC
| | - K. A. Winter
- Boston Medical Center, Boston, MA; ACR/RTOG, Philadelphia, PA; Washington University School of Medicine, St. Louis, MO; Dalhousie University, Halifax, NS, Canada; Mayo Clinic, Rochester, MN; SUNY Health Science Center, Brooklyn, NY; Duke University Medical Center, Durham, NC
| | - R. J. Myerson
- Boston Medical Center, Boston, MA; ACR/RTOG, Philadelphia, PA; Washington University School of Medicine, St. Louis, MO; Dalhousie University, Halifax, NS, Canada; Mayo Clinic, Rochester, MN; SUNY Health Science Center, Brooklyn, NY; Duke University Medical Center, Durham, NC
| | - M. D. Goodyear
- Boston Medical Center, Boston, MA; ACR/RTOG, Philadelphia, PA; Washington University School of Medicine, St. Louis, MO; Dalhousie University, Halifax, NS, Canada; Mayo Clinic, Rochester, MN; SUNY Health Science Center, Brooklyn, NY; Duke University Medical Center, Durham, NC
| | - J. Willins
- Boston Medical Center, Boston, MA; ACR/RTOG, Philadelphia, PA; Washington University School of Medicine, St. Louis, MO; Dalhousie University, Halifax, NS, Canada; Mayo Clinic, Rochester, MN; SUNY Health Science Center, Brooklyn, NY; Duke University Medical Center, Durham, NC
| | - J. Esthappan
- Boston Medical Center, Boston, MA; ACR/RTOG, Philadelphia, PA; Washington University School of Medicine, St. Louis, MO; Dalhousie University, Halifax, NS, Canada; Mayo Clinic, Rochester, MN; SUNY Health Science Center, Brooklyn, NY; Duke University Medical Center, Durham, NC
| | - M. G. Haddock
- Boston Medical Center, Boston, MA; ACR/RTOG, Philadelphia, PA; Washington University School of Medicine, St. Louis, MO; Dalhousie University, Halifax, NS, Canada; Mayo Clinic, Rochester, MN; SUNY Health Science Center, Brooklyn, NY; Duke University Medical Center, Durham, NC
| | - M. Rotman
- Boston Medical Center, Boston, MA; ACR/RTOG, Philadelphia, PA; Washington University School of Medicine, St. Louis, MO; Dalhousie University, Halifax, NS, Canada; Mayo Clinic, Rochester, MN; SUNY Health Science Center, Brooklyn, NY; Duke University Medical Center, Durham, NC
| | - P. J. Parikh
- Boston Medical Center, Boston, MA; ACR/RTOG, Philadelphia, PA; Washington University School of Medicine, St. Louis, MO; Dalhousie University, Halifax, NS, Canada; Mayo Clinic, Rochester, MN; SUNY Health Science Center, Brooklyn, NY; Duke University Medical Center, Durham, NC
| | - C. G. Willett
- Boston Medical Center, Boston, MA; ACR/RTOG, Philadelphia, PA; Washington University School of Medicine, St. Louis, MO; Dalhousie University, Halifax, NS, Canada; Mayo Clinic, Rochester, MN; SUNY Health Science Center, Brooklyn, NY; Duke University Medical Center, Durham, NC
| |
Collapse
|
35
|
Schreiber D, Rineer J, Sura S, Teper E, Nabhani T, Han P, Schwartz D, Choi K, Rotman M. Radical prostatectomy for cT3-4 disease: an evaluation of the pathological outcomes and patterns of care for adjuvant radiation in a national cohort. BJU Int 2010; 108:360-5. [PMID: 21087395 DOI: 10.1111/j.1464-410x.2010.09875.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David Schreiber
- Department of Radiation Oncology, State University of New York-Downstate, Brooklyn, NY 11209, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Schreiber D, Nwokedi E, Rineer J, Katsoulakis E, Surapaneni A, Boo D, Han P, Choi K, Rotman M, Schwartz D. Socioeconomic and Racial Disparities in the Selection of Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
37
|
Sura S, Olsheski M, Rineer J, Surapaneni A, Wortham A, Sroufe R, Han P, Choi K, Rotman M, Schreiber D. Effect of Histology on Survival for Patients with Invasive Non-metastatic Cervical Cancer: Review of the SEER Database. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
38
|
Katsoulakis E, Nabhani T, Schreiber D, Wortham A, Olsheski M, Sura S, Sroufe R, Choi K, Schwartz D, Rotman M. Response to Treatment for Prostate Cancer in Patients with Human Immunodeficiency Virus. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
39
|
Olsheski M, Salame G, Abulafia O, Rotman M, Lee Y, Han P, Schwartz M, Choi W, Gasson C, Choi K. Postoperative Concomitant Cisplatin-based Chemoradiation in Patients with Endometrial Carcinoma at High Risk for Recurrence. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
40
|
Schreiber D, Rineer J, Yu JB, Olsheski M, Nwokedi E, Schwartz D, Choi K, Rotman M. Analysis of pathologic extent of disease for clinically localized prostate cancer after radical prostatectomy and subsequent use of adjuvant radiation in a national cohort. Cancer 2010; 116:5757-66. [DOI: 10.1002/cncr.25561] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/05/2010] [Accepted: 07/07/2010] [Indexed: 11/11/2022]
|
41
|
Schefter TE, Moughan J, Kwon JS, Stuhr K, Rotman M, Yaremko BP, Small W, Gaffney DK. RTOG 0417: A phase II study of bevacizumab in combination with definitive radiotherapy and cisplatin chemotherapy in untreated patients with locally advanced cervical carcinoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
42
|
Gillison ML, Zhang Q, Ang K, Fu KK, Hammond ME, Jordan R, Trotti A, Spencer S, Rotman M, Chung CH. Analysis of the effect of p16 and tobacco pack-years (p-y) on overall (OS) and progression-free survival (PFS) for patients with oropharynx cancer (OPC) in Radiation Therapy Oncology Group (RTOG) protocol 9003. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
43
|
Zachariah B, Gwede CK, James J, Ajani J, Chin LJ, Donath D, Rosenthal SA, Kane BL, Rotman M, Berk L, Kachnic LA. Octreotide acetate in prevention of chemoradiation-induced diarrhea in anorectal cancer: randomized RTOG trial 0315. J Natl Cancer Inst 2010; 102:547-56. [PMID: 20339140 DOI: 10.1093/jnci/djq063] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In anorectal cancer patients, an acute side effect of chemoradiotherapy is gastrointestinal toxicity, which often impedes treatment delivery. Based on previous trials, octreotide acetate is widely recommended for the control of chemotherapy-induced diarrhea. However, the effectiveness of octreotide in preventing or controlling radiation- and chemoradiation-induced diarrhea is not known. METHODS A randomized, double-blinded, placebo-controlled trial was designed to determine the efficacy of long-acting octreotide acetate (LAO) in preventing the onset of acute diarrhea in patients undergoing chemoradiation therapy for rectal or anal cancer. Between 4 and 7 days before the start of radiation therapy, patients received a 30-mg dose of LAO (109 patients) or placebo (106 patients) via intramuscular injection. A second dose was given on day 22 (+/-3 days) of radiation treatment. A total of 215 patients were included in the final analysis. The primary endpoint was the incidence of grade 2-4 acute diarrhea; secondary endpoints included treatment compliance, medical resource utilization, patient-reported bowel function, and quality of life (QoL). Statistical tests were one- or two-sided, as specified. RESULTS After a median follow-up time of 9.64 months, incidence rates of grades 2-4 acute diarrhea were similar in both groups (49% placebo vs 44% LAO; P = .21). No statistically significant treatment differences in chemotherapy or radiation delivery, medical resource utilization, patient-reported bowel function, or QoL were observed. CONCLUSION In this study, the prophylactic use of LAO did not prevent the incidence or reduce the severity of diarrhea and had no notable impact on patient-reported bowel function or QoL.
Collapse
|
44
|
Schreiber D, Rineer J, Weedon J, Vongtama D, Wortham A, Kim A, Han P, Choi K, Rotman M. Survival outcomes with the use of surgery in limited-stage small cell lung cancer: should its role be re-evaluated? Cancer 2010; 116:1350-7. [PMID: 20082453 DOI: 10.1002/cncr.24853] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although chemotherapy and radiation therapy currently are recommended in limited-stage small cell lung cancer (L-SCLC), several small series have reported favorable survival outcomes in patients who underwent surgical resection. The authors of this report used a US population-based database to determine survival outcomes of patients who underwent surgery. METHODS The Surveillance, Epidemiology, and End Results (SEER) registry was used to identify patients who were diagnosed with L-SCLC between 1988 and 2002 coded by SEER as localized disease (T1-T2Nx-N0) or regional disease (T3-T4Nx-N0). Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) for all patients. RESULTS In total, 14,179 patients were identified, including 863 patients who underwent surgical resection. Surgery was associated more commonly with T1/T2 disease (P < .001). Surgery was associated with improved survival for both localized disease and regional disease with improvements in median survival from 15 months to 42 months (P < .001) and from 12 months to 22 months (P < .001), respectively. Lobectomy was associated with the best outcome (P < .001). Patients with localized disease who underwent lobectomy with had a median survival of 65 months and a 5-year OS rate of 52.6%; whereas patients who had regional disease had a median survival of 25 months and a 5-year OS rate of 31.8%. On multivariate analysis, the benefit of surgery varied in a time-dependant fashion. However, the benefit of lobectomy remained across all time intervals (P = .002). CONCLUSIONS The use of surgery, and particularly lobectomy, in selected patients with L-SCLC was associated with improved survival outcomes. Future prospective studies should consider the role of surgery as part of the multimodality management of this disease.
Collapse
Affiliation(s)
- David Schreiber
- Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Rineer J, Schreiber D, Katsoulakis E, Nabhani T, Han P, Lange C, Choi K, Rotman M. Survival Following Sublobar Resection for Early-Stage Non-Small Cell Lung Cancer With or Without Adjuvant External Beam Radiation Therapy. Chest 2010; 137:362-8. [DOI: 10.1378/chest.09-0868] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
46
|
Portelance L, Winter K, Jhingran A, Miller B, Salehpour M, D'Souza D, Haddock M, Rotman M, Gaffney D. Post-operative Pelvic Intensity Modulated Radiation Therapy (IMRT) with Chemotherapy for Patients with Cervical Carcinoma/RTOG 0418 Phase II Study. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
47
|
Khor LY, Bae K, Paulus R, Al-Saleem T, Hammond ME, Grignon DJ, Che M, Venkatesan V, Byhardt RW, Rotman M, Hanks GE, Sandler HM, Pollack A. MDM2 and Ki-67 predict for distant metastasis and mortality in men treated with radiotherapy and androgen deprivation for prostate cancer: RTOG 92-02. J Clin Oncol 2009; 27:3177-84. [PMID: 19470936 DOI: 10.1200/jco.2008.19.8267] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE MDM2 regulates p53, which controls cell cycle arrest and apoptosis. Both proteins, along with Ki-67, which is an established strong determinant of metastasis, have shown promise in predicting the outcome of men treated with radiation therapy (RT) with or without short-term androgen deprivation (STAD). This report compares the utility of abnormal expression of these biomarkers in estimating progression in a cohort of men treated on RTOG 92-02. PATIENTS AND METHODS Adequate tissue for immunohistochemistry was available for p53, Ki-67, and MDM2 analyses in 478 patient cases. The percentage of tumor nuclei staining positive (PSP) was quantified manually or by image analysis, and the per-sample mean intensity score (MIS) was quantified by image analysis. Cox regression models were used to estimate overall mortality (OM), and Fine and Gray's regressions were applied to the end points of distant metastasis (DM) and cause-specific mortality (CSM). Results In multivariate analyses that adjusted for all markers and treatment covariates, MDM2 overexpression was significantly related to DM (P = .02) and OM (P = .003), and Ki-67 overexpression was significantly related to DM (P < .0001), CSM (P = .0007), and OM (P = .01). P53 overexpression was significantly related to OM (P = .02). When considered in combination, the overexpression of both Ki-67 and MDM2 at high levels was associated with significantly increased failure rates for all end points (P < .001 for DM, CSM, and OM). CONCLUSION Combined MDM2 and Ki-67 expression levels were independently related to distant metastasis and mortality and, if validated, could be considered for risk stratification of patients with prostate cancer in clinical trials.
Collapse
Affiliation(s)
- Li-Yan Khor
- Department of Radiation Oncology, University of Miami, Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Suite 1501, Miami, FL 33130, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Wortham AH, Schreiber D, Rineer J, Katsoulakis E, Sroufe R, Marienberg E, Nwokedi E, Han P, Choi K, Rotman M. Overall survival using local excision techniques with and without radiation compared with APR for stage I rectal cancer: A SEER based analysis. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4032 Background: The standard of care for Stage I rectal cancer is radical resection. Increasingly, local therapies have been used to decrease morbidity and preserve sphincter control. Due to increased risk of local recurrence with less radical surgery, patients often receive adjuvant radiation. This analysis compares the outcomes of sphincter sparing treatment with radical surgery in Stage I rectal cancer. Methods: Using the Surveillance, Epidemiology and End-Results (SEER) registry, we performed a query of patients with Stage T1–2N0 (T=4 cm or less) rectal adenocarcinoma between 1988 and 2003 who were treated with either local excision alone (LE), local excision followed by radiotherapy (LE+RT) or abdominoperineal resection (APR). APR was selected as comparison group to select for a similar cohort of patients with distal tumors that would be eligible for LE. Kaplan-Meier analysis was performed to compare overall survival for patients receiving radical surgery versus local therapy. Subgroup survival analysis was performed by T-stage (T1 vs T2). Results: 2,144 patients were identified: 744 were treated with LE alone, 197 underwent LE+RT, and 1203 underwent APR. Patients undergoing LE ± RT had a median survival (MS) of 131 vs 121 months in the APR group (p=0.574). When comparing LE vs LE+RT, there was no difference in MS for the whole cohort (134 vs 108 months, p=0.39). However, on subgroup analysis there was a significant survival benefit in favor of LE+RT for T2N0 only (104 vs 74 months, p=0.048). For T1N0, the MS for LE+RT was 161 vs 147 months for LE (p=0.621). Comparing with APR, patients undergoing LE+RT had a MS of 108 vs 121 months in the APR group (p=0.684). For T1N0, the MS for LE+RT was 161 vs 153 months for APR (p=0.62). For T2N0 patients, the MS for LE+RT was 104 vs 114 months for APR (p=0.726). Conclusions: According to this analysis, there was no statistical difference in survival for patients with Stage I rectal carcinoma undergoing APR versus LE+RT. Selected patients with T1N0 may undergo local excision alone. However, patients with T2N0 disease should undergo adjuvant radiation after local excision. The risks and benefits of these treatment strategies should be weighed and treatment should be individualized. No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | | | - J. Rineer
- SUNY Downstate Medical Center, Brooklyn, NY
| | | | - R. Sroufe
- SUNY Downstate Medical Center, Brooklyn, NY
| | | | - E. Nwokedi
- SUNY Downstate Medical Center, Brooklyn, NY
| | - P. Han
- SUNY Downstate Medical Center, Brooklyn, NY
| | - K. Choi
- SUNY Downstate Medical Center, Brooklyn, NY
| | - M. Rotman
- SUNY Downstate Medical Center, Brooklyn, NY
| |
Collapse
|
49
|
Schreiber D, Rineer J, Olsheski M, Vongtama D, Wortham A, Sura S, Nwokedi E, Han P, Choi K, Rotman M. Radical prostatectomy in clinically localized prostate cancer—The risk of extraprostatic spread by NCCN risk group and its implications for adjuvant therapy: An analysis of 23,988 patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5125 Background: Swanson et al recently reported an update of SWOG 8794 (ASTRO 2008, oral presentation) revealing a 10% absolute overall survival benefit at 15 years with adjuvant radiation therapy for patients with extraprostatic extension (EPE) or positive margins after radical prostatectomy (RP). In this population based analysis, we analyze and report on the pathologic rates of EPE or positive margins in clinically localized prostate cancer as well as how often these patients have received adjuvant radiation therapy. Methods: The Surveillance, Epidemiology and End Results (SEER) registry was used to identify patients between 2004–2005 with clinically staged T1-T2c prostate cancer who underwent RP. Patients were stratified using NCCN risk groups into low (T1c- T2a, PSA less than 10ng/ml, Gleason 2–6), intermediate (T2b, PSA 10–20ng/ml, Gleason 7), and high (T2c, PSA greater than 20ng/ml, Gleason 8–10). Results: 23,988 patients were identified: 6,314 in the NCCN low risk group (LR), 12,052 in the NCCN intermediate risk group (IR), and 5,622 in the NCCN high risk group (HR). Overall, 68.2% of patients had organ-confined disease with negative margins. However, the risk of EPE or positive margins increased with the NCCN risk group, PSA value, and Gleason score (see table ). Of those who met criteria for adjuvant radiation, 11.9% received the treatment: 4.7% of the LR group, 9.2% of the IR group and 18.9% of the HR group. Conclusions: This is, to our knowledge, the largest reported multi-institutional surgical series of clinically localized prostate cancer. Patients can use this data to be counseled on their risk of requiring adjuvant radiation based on their pre-treatment parameters. This data also reveals that nearly one third of all patients met the indications for adjuvant radiation, but only a small percentage of them received this treatment. [Table: see text] No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | - J. Rineer
- SUNY Downstate Medical Center, Brooklyn, NY
| | | | | | - A. Wortham
- SUNY Downstate Medical Center, Brooklyn, NY
| | - S. Sura
- SUNY Downstate Medical Center, Brooklyn, NY
| | - E. Nwokedi
- SUNY Downstate Medical Center, Brooklyn, NY
| | - P. Han
- SUNY Downstate Medical Center, Brooklyn, NY
| | - K. Choi
- SUNY Downstate Medical Center, Brooklyn, NY
| | - M. Rotman
- SUNY Downstate Medical Center, Brooklyn, NY
| |
Collapse
|
50
|
Rineer J, Schreiber D, Wortham A, Olsheski M, Sroufe R, Sura S, Katsoulakis E, Han P, Choi K, Rotman M. Utilization of radiation therapy in early-stage Hodgkin disease and its impact on survival. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8511 Background: Despite numerous randomized trials confirming the benefit of consolidation radiation therapy (RT) in the management of early stage Hodgkin disease (HD), utilization of RT in this setting remains variable. We performed a population-based analysis to assess the utilization of RT and its impact on overall and cause specific survival. Methods: The surveillance, epidemiology and end results (SEER) registry was used to identify patients aged 15–75 years diagnosed between 1990–2004 with early stage (stage I-IIA/B) HD, excluding nodular lymphocyte predominant HD. Kaplan-Meier analysis was performed to evaluate the effect of RT on overall survival (OS) and cause-specific survival (CSS). Subgroup survival analyses were also performed by era of treatment (1990–1997 and 1998–2004), sex, and patient age (<30, 30–50, and >50 years). Results: A total of 9729 patients met inclusion criteria. Median age of all patients was 34 years. The majority (71.3%) had nodular sclerosis (NS) type HD. By clinical stage, 3399 (34.9%) were stage I, and 6330 (65.1%) were stage II. 5352 patients (55%) received RT. RT was more likely to be employed during the early era of treatment, in younger patients, females, non-Blacks, and in NS, mixed cellularity and lymphocyte-rich HD. For the entire cohort, RT was associated with a significant (p<0.001) improvement in OS and CSS (hazard ratio of 0.537 and 0.437, respectively). The benefit of RT for OS and CSS remained significant for all subgroups analyzed including the era of treatment, sex, and age (p≤0.001). Conclusions: In this large population-based series of early stage HD patients, the use of RT is associated with a significant OS and CSS benefit across all subgroups. Current efforts in clinical trials have aimed at decreasing the utilization of RT among this patient population. This shift in practice is reflected in the data presented here. The omission of RT from the treatment paradigm, however, appears to be related with diminished survival. No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | | | | | | | | | - S. Sura
- SUNY Downstate, Brooklyn, NY
| | | | - P. Han
- SUNY Downstate, Brooklyn, NY
| | - K. Choi
- SUNY Downstate, Brooklyn, NY
| | | |
Collapse
|