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Ruspi L, Cananzi FCM, Sicoli F, Samà L, Renne SL, Marrari A, Gennaro N, Colombo P, Cozzaglio L, Politi LS, Bertuzzi A, Quagliuolo V. Event-free survival in Desmoid-Type fibromatosis (DTF): A pre-post comparison of upfront surgery versus wait-and-see approach. Eur J Surg Oncol 2020; 47:1196-1200. [PMID: 32847695 DOI: 10.1016/j.ejso.2020.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/31/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Desmoid-Type Fibromatosis (DTF) is a rare mesenchymal neoplasm with a locally invasive pattern and high risk of local recurrence after surgery. Historically, the standard treatment for DTF was surgical resection. However, considering the difficulty of achieving surgical eradication, the possible unnecessary morbidity and the unpredictability of the natural history, a wait-and-see approach has been proposed for asymptomatic DTF. METHODS We analyzed 87 consecutive patients with histologically-proven sporadic primary DTF, first recurrence or residual disease managed at our institution between 2000 and 2018. Patients and tumor-related variables were reviewed and analyzed. Two different treatment strategies were adopted according to different time periods: in the "early period" (2000-2010) patients underwent surgical treatment irrespective of the clinical presentation, whereas in the "late period" (2012-2018) asymptomatic patients used to undergo a wait-and-see strategy. The event-free survival (EFS) was compared trough a pre-post comparison. RESULTS In the early period, surgery was performed in 51 (94.4%) patients and watchful waiting in 3 (5.6%). In the late period, the watchful waiting group accounted for 24 (72.7%) patients and the surgical group for 9 (27.3%). No statistically independent prognostic factors were found. EFS did not show statistically significant differences between early and late period groups. CONCLUSION Wait-and-see policy has shown to be equivalent to upfront surgery in terms of EFS; therefore, a conservative approach is recommended in asymptomatic patients diagnosed with DTF that can be followed through watchful waiting.
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Affiliation(s)
- Laura Ruspi
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy
| | - Ferdinando Carlo Maria Cananzi
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy.
| | - Federico Sicoli
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Laura Samà
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy
| | - Salvatore Lorenzo Renne
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy; Pathology Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Andrea Marrari
- Oncology Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Nicolò Gennaro
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy; Neuroradiology Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Piergiuseppe Colombo
- Pathology Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luca Cozzaglio
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Letterio Salvatore Politi
- Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy; Neuroradiology Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alexia Bertuzzi
- Oncology Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Vittorio Quagliuolo
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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Abstract
Symptomatic atrial fibrillation (AF) is a common cause of emergency department (ED) referrals. In case of hemodynamic stability, the choice to either perform early cardioversion (pharmacologic or electrical) or to prescribe rate-lowering drugs and differ any attempts to restore sinus rhythm (i.e., wait-and-see approach) has been widely debated. Results of the recent Rate Control versus Electrical Cardioversion Trial 7-Acute Cardioversion versus Wait and See (RACE 7 ACWAS) have been considered a strong argument in favor of the wait-and-see approach. In this debate, we discuss several issues that would support early cardioversion, ranging from patients' satisfaction and costs to concerns about safety. Furthermore, the wait-and-see approach may translate into a missed opportunity to encourage widespread use of a "pill-in-the-pocket" home treatment: this underused option could allow rapid solving of many AF episodes, potentially avoiding future ED referrals. Our opinion is that a delayed cardioversion may introduce unneeded complications in the straightforward management of a common clinical problem. Therefore, early cardioversion should continue to be the preferred option because of its proven efficacy, safety and convenience.
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Affiliation(s)
- Alessandro Capucci
- Cardiology and Arrhythmology Clinic, Marche Polytechic University, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche Polytechic University, University Hospital "Ospedali Riuniti", Ancona, Italy.
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Yeom SS, Lee SY, Kim CH, Kim YJ, Nam TK, Kim HR. Non-operative treatment outcome for rectal cancer patient with clinical complete response after neoadjuvant chemoradiotherapy. Asian J Surg 2019; 42:823-31. [PMID: 30956039 DOI: 10.1016/j.asjsur.2018.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/27/2018] [Accepted: 12/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Among rectal cancer patients, some of good responders after neoadjuvant chemoradiotherapy (nCRT) are considered for non-operative treatments to avoid postoperative morbidities and permanent stoma. However, oncologic feasibility of non-operative treatment has not been fully understood. METHODS From 2008 to 2017, we retrospectively reviewed patient's records who had lower or mid rectal cancer and diagnosed to clinical complete response by magnetic resonance imaging after nCRT. Clinical differences and oncologic outcomes were compared among Radical surgery (RS), Local excision (LE) and Wait-and-see (WS) group. RESULTS Number of 129, 25, 15 patients included to RS, LE, WS groups. Local recurrence was frequent type of recurrence in both of LE and WS group (RS; 31.3%, LE; 80%, WS; 66.7%), and many patients in WS group omitted salvage treatment (RS; 75%, LE; 100%, WS; 33.3%). 5-years local-recurrence/disease-free survival rate (LRFS, DFS) between RS and LE were similar between each group, but WS showed significantly inferior outcomes than that of RS (LRFS; p = 0.001, DFS; p = 0.001). In multivariate analysis, WS protocol (OR; 7.163, 95% CI; 1.995-25.715) and cT4 stage (OR; 8.206, 95% CI; 1.596-42.198) were independent factors for LRFS. CONCLUSIONS Wait-and-see group showed high rate of rejection of salvage treatments for recurrence, and poor oncologic outcomes. However, recent low-level evidences reported favorable outcome of WS protocol when salvage treatment was followed after recurrence. It seems that the application of WS protocol should be postponed until the results of randomized-controlled trials are available. Local excision seems to be good alternative option to radical surgery when salvage treatment is followed.
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Abstract
From a speech-language pathology perspective, there is a gap in interprofessional education/practice (IPE/IPP) that leads to a wait-and-see approach with late talkers (LT). In line with the American Speech-Language-Hearing Association's Strategic Pathway to Excellence, this article attempts to bridge the gap, reexamining the panoptic view that most LT "catch up" to their peers. The LT who persist with language disorder should not be overlooked. Late talking can impact socialization and school readiness, and can place some toddlers at risk for life-long disability. Each state's early intervention program has an established IPP infrastructure. Parent-implemented intervention addresses risks and maximizes protective factors.
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Affiliation(s)
- Nina Capone Singleton
- Department of Speech-Language Pathology, School of Health and Medical Sciences, Seton Hall University, 400 South Orange Avenue, South Orange, NJ 07079, USA.
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Takahashi R, Akamoto S, Nagao M, Matsuura N, Fujiwara M, Okano K, Suzuki Y. Follow-up of asymptomatic adult diaphragmatic hernia: should patients with this condition undergo immediate operation? A report of two cases. Surg Case Rep 2016; 2:95. [PMID: 27612870 PMCID: PMC5017960 DOI: 10.1186/s40792-016-0220-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/11/2016] [Accepted: 09/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asymptomatic diaphragmatic hernia is generally thought to be rare among adults. We present two different types of asymptomatic diaphragmatic hernia diagnosed with computed tomography (CT) and discuss treatment strategies. CASE PRESENTATION Case 1: A 37-year-old woman was diagnosed with catamenial pneumothorax in the right diaphragm. Partial resection of the diaphragm and lung was performed using a linear stapler. She was asymptomatic after the operation and gave birth 2 years later. After delivery, she experienced recurrent pneumothorax, and CT revealed a right diaphragmatic defect with herniation of a part of the liver into the thorax. An iatrogenic diaphragmatic hernia was diagnosed. There has been no change in the size of the hernia and no symptoms due to the diaphragmatic hernia for more than 3 years after it was diagnosed. Case 2: A 75-year-old woman was previously diagnosed with rectal cancer and had undergone surgery after chemoradiotherapy. One year after surgery, herniation of a 3 × 1.3-cm section of retroperitoneal fat tissue into the left thoracic cavity was observed incidentally at a follow-up CT and was diagnosed as an adult Bochdalek hernia (BH). We reviewed the patient's past CT findings and confirmed that the same finding had been present since the first scan. A wait-and-see approach was chosen because there had been no change in the size of hernia, there were no symptoms, the patient was elderly, and there was a high risk of recurrence of the rectal cancer. She has had no symptoms to date, and careful follow-up has been performed. CONCLUSIONS There are few reports of asymptomatic adult diaphragmatic hernia. Although symptomatic diaphragmatic hernia is generally treated surgically, there are cases in which a wait-and-see approach has been applied, such as our asymptomatic cases.
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Affiliation(s)
- Ryota Takahashi
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Shintaro Akamoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Mina Nagao
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Natsumi Matsuura
- Department of General Thoracic, Breast, and Endocrinological Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita, Kagawa, 761-0793, Japan
| | - Masao Fujiwara
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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van Broekhoven DLM, Grünhagenl DJ, van Dalen T, van Coevorden F, Bonenkamp HJ, Been LB, Bemelmans MHA, Dijkstra SDS, Colombo C, Gronchi A, Verhoef C. Tailored Beta-catenin mutational approach in extra-abdominal sporadic desmoid tumor patients without therapeutic intervention. BMC Cancer 2016; 16:686. [PMID: 27565718 PMCID: PMC5000483 DOI: 10.1186/s12885-016-2704-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 11/19/2015] [Accepted: 08/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background The efficacy of the classical treatment modalities surgery and radiotherapy in the treatment of aggressive fibromatosis is presently disputed and there is a shift towards a more conservative approach. The aim of the present study is to objectify tumor growth in patients with extra-abdominal or abdominal wall aggressive fibromatosis, while adhering to a “watchful waiting” policy. Other objectives are to investigate quality of life and to identify factors associated with tumor growth, in particular the relation with the presence of a CTNNB1-gene mutation in the tumor. Design and methods GRAFITI is a nationwide, multicenter, prospective registration trial. All patients with extra-abdominal or abdominal wall aggressive fibromatosis are eligible for inclusion in the study. Main exclusion criteria are: history of familiar adenomatous polyposis, severe pain, functional impairment, life/limb threating situations in case of progressive disease. Patients included in the study will be treated with a watchful waiting policy during a period of 5 years. Imaging studies with ultrasound and magnetic resonance imaging scan will be performed during follow-up to monitor possible growth: the first years every 3 months, the second year twice and the yearly. In addition patients will be asked to complete a quality of life questionnaire on specific follow-up moments. The primary endpoint is the rate of progression per year, defined by the Response Evaluation Criteria In Solid Tumors (RECIST). Secondary endpoints are quality of life and the rate of influence on tumor progression for several factors, such as CTNNB1-mutations, age and localization. Discussion This study will provide insight in tumor behavior, the effect on quality of life and clinicopathological factors predictive of tumor progression. Trial registration The GRAFITI trial is registered in the Netherlands National Trial Register (NTR), number 4714.
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Affiliation(s)
| | | | | | | | - Han J Bonenkamp
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lukas B Been
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Chiara Colombo
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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van der Heijden M, Dikkers FG, Halmos GB. Treatment outcome of supraglottoplasty vs. wait-and-see policy in patients with laryngomalacia. Eur Arch Otorhinolaryngol 2016; 273:1507-13. [PMID: 26924742 PMCID: PMC4858546 DOI: 10.1007/s00405-016-3943-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/18/2016] [Indexed: 11/29/2022]
Abstract
In most cases, laryngomalacia presents as a mild disease, and the symptoms resolve after wait-and-see policy. Up to 20 % of patients present with severe laryngomalacia and may require surgery (i.e. supraglottoplasty); however, the indication for surgery is not firmly established yet. The goal of this study is to determine whether supraglottoplasty results in a better outcome than wait-and-see and to investigate how different comorbidities influence outcome. A retrospective study of pediatric cases of in a tertiary referral center was performed. Photo and video documentation was available and revised in all cases. Electronic and paper charts were reviewed for the following variables: gender, sex, gestational age, birth weight, symptoms, comorbidity, date of endoscopy, severity and type of laryngomalacia, treatment modality and technique and follow-up data and a total 89 patients were included. Supraglottoplasty was found to lead to significantly faster complete improvement of laryngomalacia than wait-and-see policy (5 weeks vs. 29, p = 0.026). Synchronous airway lesions (SALs) were present in 40.4 % of patients and were associated with prolonged symptoms of laryngomalacia (38.5 weeks vs. 14.5, p = 0.043). Supraglottoplasty is safe and effective in treatment of severe laryngomalacia. SALs and comorbidities are frequently found in patients with laryngomalacia and are responsible for longer onset of complaints.
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Affiliation(s)
- Martijn van der Heijden
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Frederik G Dikkers
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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Khan OH, Mason W, Kongkham PN, Bernstein M, Zadeh G. Neurosurgical management of adult diffuse low grade gliomas in Canada: a multi-center survey. J Neurooncol 2015; 126:137-149. [PMID: 26454818 PMCID: PMC4683163 DOI: 10.1007/s11060-015-1949-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 01/02/2015] [Accepted: 10/05/2015] [Indexed: 11/21/2022]
Abstract
Adult diffuse low-grade gliomas are slow growing, World Health Organization grade II lesions with insidious onset and ultimate anaplastic transformation. The timing of surgery remains controversial with polarized practices continuing to govern patient management. As a result, the management of these patients is variable. The goal of this questionnaire was to evaluate practice patterns in Canada. An online invitation for a questionnaire including diagnostic, preoperative, perioperative, and postoperative parameters and three cases with magnetic resonance imaging data with questions to various treatment options in these patients was sent to practicing neurosurgeons and trainees. Survey was sent to 356 email addresses with 87 (24.7 %) responses collected. The range of years of practice was less than 10 years 36 % (n = 23), 11–20 years 28 % (n = 18), over 21 years 37 % (n = 24). Twenty-two neurosurgery students of various years of training completed the survey. 94 % (n = 47) of surgeons and trainees (n = 20) believe that we do not know the “right treatment”. 90 % of surgeons do not obtain formal preoperative neurocognitive assessments. 21 % (n = 13) of surgeons and 23 % of trainees (n = 5) perform a biopsy upon first presentation. A gross total resection was believed to increase progression free survival (surgeons: 75 %, n = 46; trainees: 95 %, n = 21) and to increase overall survival (surgeons: 64 %, n = 39, trainees: 68 %, n = 15). Intraoperative MRI was only used by 8 % of surgeons. Awake craniotomy was the procedure of choice for eloquent tumors by 80 % (n = 48) of surgeons and 100 % of trainees. Of those surgeons who perform awake craniotomy 93 % perform cortical stimulation and 38 % performed subcortical stimulation. Using the aid of three hypothetical cases with progressive complexities in tumor eloquence there was a trend for younger surgeons to operate earlier, and use awake craniotomy to obtain greater extent of resection with the aid of cortical stimulation when compared to senior surgeons who still more often preferred a “wait-and-see” approach. Despite the limitations of an online survey study, it has offered insights into the variability in surgeon practice patterns in Canada and the need for a consensus on the workup and surgical management of this disease.
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Affiliation(s)
- Osaama H Khan
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
| | - Warren Mason
- Princess Margaret Hospital, 610 University Avenue Suite 18-717, Toronto, ON, M5G 2M9, Canada
| | - Paul N Kongkham
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Mark Bernstein
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
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Wiegel T, Bartkowiak D, Bottke D, Bronner C, Steiner U, Siegmann A, Golz R, Störkel S, Willich N, Semjonow A, Stöckle M, Rübe C, Rebmann U, Kälble T, Feldmann HJ, Wirth M, Hofmann R, Engenhart-Cabillic R, Hinke A, Hinkelbein W, Miller K. Adjuvant radiotherapy versus wait-and-see after radical prostatectomy: 10-year follow-up of the ARO 96-02/AUO AP 09/95 trial. Eur Urol 2014; 66:243-50. [PMID: 24680359 DOI: 10.1016/j.eururo.2014.03.011] [Citation(s) in RCA: 304] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/07/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Local failure after radical prostatectomy (RP) is common in patients with cancer extending beyond the capsule. Three prospectively randomized trials demonstrated an advantage for adjuvant radiotherapy (ART) compared with a wait-and-see (WS) policy. OBJECTIVE To determine the efficiency of ART after a 10-yr follow-up in the ARO 96-02 study. DESIGN, SETTING, AND PARTICIPANTS After RP, 388 patients with pT3 pN0 prostate cancer (PCa) were randomized to WS or three-dimensional conformal ART with 60 Gy. The present analysis focuses on intent-to-treat patients who achieved an undetectable prostate-specific antigen after RP (ITT2 population)--that is, 159 WS plus 148 ART men. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary end point of the study was progression-free survival (PFS) (events: biochemical recurrence, clinical recurrence, or death). Outcomes were compared by log-rank test. Cox regression analysis served to identify variables influencing the course of disease. RESULTS AND LIMITATIONS The median follow-up was 111 mo for ART and 113 mo for WS. At 10 yr, PFS was 56% for ART and 35% for WS (p<0.0001). In pT3b and R1 patients, the rates for WS even dropped to 28% and 27%, respectively. Of all 307 ITT2 patients, 15 died from PCa, and 28 died for other or unknown reasons. Neither metastasis-free survival nor overall survival was significantly improved by ART. However, the study was underpowered for these end points. The worst late sequelae in the ART cohort were one grade 3 and three grade 2 cases of bladder toxicity and two grade 2 cases of rectum toxicity. No grade 4 events occurred. CONCLUSIONS Compared with WS, ART reduced the risk of (biochemical) progression with a hazard ratio of 0.51 in pT3 PCa. With only one grade 3 case of late toxicity, ART was safe. PATIENT SUMMARY Precautionary radiotherapy counteracts relapse after surgery for prostate cancer with specific risk factors.
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Affiliation(s)
- Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany.
| | - Detlef Bartkowiak
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Dirk Bottke
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Claudia Bronner
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Ursula Steiner
- Department of Urology, Charité Universitätsmedizin, Campus Benjamin- Franklin, Berlin, Germany
| | - Alessandra Siegmann
- Department of Radiation Oncology, Charité Universitätsmedizin, Campus Benjamin- Franklin, Berlin, Germany
| | - Reinhard Golz
- Department of Pathology, Helios-Clinic Wuppertal, Wuppertal, Germany
| | - Stephan Störkel
- Department of Pathology, Helios-Clinic Wuppertal, Wuppertal, Germany
| | - Normann Willich
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
| | - Axel Semjonow
- Department of Urology, University Hospital Münster, Münster, Germany
| | - Michael Stöckle
- Department of Urology, University Hospital Homburg/Saar, Homburg, Germany
| | - Christian Rübe
- Department of Radiation Oncology, University Hospital Homburg/Saar, Homburg, Germany
| | - Udo Rebmann
- Department of Urology, Diakonissen-Krankenhaus Dessau, Dessau-Rosslau, Germany
| | - Tilman Kälble
- Department of Urology, General Hospital Fulda, Fulda, Germany
| | | | - Manfred Wirth
- Department of Urology, University Hospital Dresden, Dresden, Germany
| | - Rainer Hofmann
- Departments of Urology, University Hospital Giessen-Marburg, Marburg, Germany
| | | | | | - Wolfgang Hinkelbein
- Department of Radiation Oncology, Charité Universitätsmedizin, Campus Benjamin- Franklin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité Universitätsmedizin, Campus Benjamin- Franklin, Berlin, Germany
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