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Chilukuri S, Mallick I, Agrawal A, Maitre P, Arunsingh M, James FV, Kataria T, Narang K, Gurram BC, Anand AK, Utreja N, Dutta D, Pavamani S, Mitra S, Mallik S, Mahale N, Chandra M, Chinnachamy AN, Shahid T, Raghunathan MS, Kannan V, Mohanty SK, Basu T, Hotwani C, Panigrahi G, Murthy V. Multi-Institutional Clinical Outcomes of Biopsy Gleason Grade Group 5 Prostate Cancers Treated With Contemporary High-Dose Radiation and Long-Term Androgen Deprivation Therapy. Clin Oncol (R Coll Radiol) 2023; 35:454-462. [PMID: 37061457 DOI: 10.1016/j.clon.2023.03.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023]
Abstract
AIMS This multicentric retrospective study reports long-term clinical outcomes of non-metastatic grade group 5 prostate cancers treated with external beam radiotherapy (EBRT) alone with long-term androgen deprivation therapy (ADT). MATERIALS AND METHODS Patients treated across 19 institutions were studied. The key endpoints that were evaluated were 5-year biochemical recurrence-free survival (bRFS), metastases-free survival (MFS), overall survival, together with EBRT-related acute and late toxicities. The impact of various prognostic factors on the studied endpoints was analysed using univariate and multivariate analyses. RESULTS Among the 462 patients, 88% (405) had Gleason 9 disease and 31% (142) had primary Gleason pattern 5. A prostate-specific membrane antigen positron emission tomography-computed tomography scan was used for staging in 33% (153), 80% (371) were staged as T3/T4 and 30% (142) with pelvic nodal disease. The median ADT duration was 24 months; 66% received hypofractionated EBRT and 71.4% (330) received pelvic nodal irradiation. With a median follow-up of 56 months, the 5-year bRFS, MFS and overall survival were 73.1%, 77.4% and 90.5%, respectively. Primary Gleason pattern 5 was associated with worse bRFS, MFS and overall survival with hazard ratios of 0.51 (95% confidence interval 0.35 to 0.73, P < 0.001), 0.64 (95% confidence interval 0.43 to 0.96, P = 0.031) and 0.52 (95% confidence interval 0.28 to 0.97, P = 0.040), respectively, whereas pelvic nodal disease was associated with worse bRFS (hazard ratio 0.67, 95% confidence interval 0.46 to 0.98, P = 0.039) and MFS (hazard ratio 0.56, 95% confidence interval 0.37 to 0.85, P = 0.006). The acute and late radiation-related toxicities were low overall and pelvic nodal irradiation was associated with higher toxicities. CONCLUSION Contemporary EBRT and long-term ADT led to excellent 5-year clinical outcomes and low rates of toxicity in this cohort of non-metastatic grade group 5 prostate cancers. Primary Gleason pattern 5 and pelvic node disease portends inferior clinical outcomes.
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Affiliation(s)
- S Chilukuri
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - A Agrawal
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India
| | - P Maitre
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - F V James
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - T Kataria
- Division of Radiation Oncology, Cancer Institute, Medanta, Sector-38, Gurugram, India
| | - K Narang
- Division of Radiation Oncology, Cancer Institute, Medanta, Sector-38, Gurugram, India
| | - B C Gurram
- Department of Radiation Oncology, Yashoda Cancer Institute, Somajiguda, Hyderabad, India
| | - A K Anand
- Max Super Speciality Hospital, Saket, New Delhi, India
| | - N Utreja
- Max Super Speciality Hospital, Saket, New Delhi, India
| | - D Dutta
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, India
| | - S Pavamani
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | - S Mitra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - S Mallik
- Department of Radiation Oncology, Narayana Superspeciality Hospital, Howrah, India
| | - N Mahale
- Nirali Memorial Radiation Centre and Bharat Cancer Hospital, Surat, India
| | - M Chandra
- Department of Radiation Oncology, Jupiter Hospital, Thane, India
| | - A N Chinnachamy
- Department of Radiation Oncology, VN Cancer Centre, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - T Shahid
- Department of Radiation Oncology, Apollo Multispeciality Hospitals, Kolkata, India
| | - M S Raghunathan
- Department of Radiotherapy, Kovai Medical Centre and Hospital, Coimbatore, India
| | - V Kannan
- Department of Radiation Oncology, P.D Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - S K Mohanty
- Department of Radiation Oncology, Sterling Cancer Hospital, Rajkot, Gujrat, India
| | - T Basu
- Department of Radiation Oncology, HCG Cancer Centre, Mumbai, India
| | - C Hotwani
- Department of Radiation Oncology, Alexis Multi-Speciality Hospital, Nagpur, India
| | - G Panigrahi
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India.
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Murthy V, Chilukuri S, Mallick I, Maitre P, Agarwal A, Moses A, James F, Narang K, Kataria T, Anand A, Dutta D, Mitra S, Pavamani S, Mallick S, Mahale N, Chandra M, Narayan A, Shahid T, Sairam M, Kannan V, Mohanty S, Basu T, Hotwani C, G B. OC-0606 Multi-institutional outcomes of Gleason grade group 5 prostate cancers treated with EBRT and ADT. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02628-7] [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: 10/18/2022]
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Iwuchukwu I, Mahale N, Ryder J, Hsieh B, Jennings B, Nguyen D, Cornwell K, Beyl R, Zabaleta J, Sothern M. Racial differences in intracerebral haemorrhage outcomes in patients with obesity. Obes Sci Pract 2018; 4:268-275. [PMID: 29951217 PMCID: PMC6010019 DOI: 10.1002/osp4.167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE This study was conducted to determine the role of obesity and race in intracerebral haemorrhage (ICH) outcomes. METHODS The Get with the guideline-Stroke database was queried for all admitted patients with spontaneous ICH. Secondary causes of ICH were excluded. Body mass index (BMI) was classified using the Center for Disease Control guidelines. Race was classified as White or non-White. Demographics, clinical, imaging data were retrieved. Outcome measures were hematoma expansion at 24 h and discharge disposition. RESULTS A total of 428 patients were included in our analysis. Female gender, past history of congestive heart failure, diabetes mellitus, HbA1c, blood pressure, ICH volume, ICH location, intraventricular haemorrhage and hospital length of stay deferred across BMI categories. On multivariate analysis, along with obese categories, age, ICH location and ICH volume were independent predictors of poor outcomes (hematoma expansion and poor discharge disposition). After adjusting for these variables, obesity remained a predictor of poor disposition outcome compared with normal and overweight subjects; Normal vs. Obese OR 0.26 CI 0.115-0.593 p = 0.0014; Obese vs. Overweight OR 3.79 CI 1.68-8.52 p = 0.0013. Nonetheless, obesity did not influence hematoma expansion. Overall, BMI-race classification did not influence outcomes. However, among non-Whites, the obese category had higher odds of a poor disposition outcome than normal (OR 6.84 CI 2.12-22.22 p = 0.0013) or overweight (OR 8.45 CI 2.6-27.49 p = 0.0004) categories. CONCLUSION An obesity paradox in ICH was not observed in our cohort. In the non-White population, patients with obesity were likely to be associated with poor disposition outcome. Similar findings were not observed in White population.
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Affiliation(s)
- I. Iwuchukwu
- Department of Neurocritical Care, Neurology and Neurosurgery, Ochsner Medical Center/Ochsner Clinical SchoolUniversity of QueenslandNew OrleansLAUSA
- Neuroscience Center of ExcellenceLouisiana State University Health Science CenterNew OrleansLAUSA
| | - N. Mahale
- Institute of Translation ResearchOchsner Clinic FoundationNew OrleansLAUSA
| | - J. Ryder
- Ochsner Clinical SchoolUniversity of QueenslandNew OrleansLAUSA
| | - B. Hsieh
- Ochsner Clinical SchoolUniversity of QueenslandNew OrleansLAUSA
| | - B. Jennings
- Department of NeurologyOchsner Medical CenterNew OrleansLAUSA
| | - D. Nguyen
- Institute of Translation ResearchOchsner Clinic FoundationNew OrleansLAUSA
| | - K. Cornwell
- School of Public HealthLouisiana State University Health Sciences CenterNew OrleansLA
| | - R. Beyl
- Department of BiostatisticsPennington Biomedical Research CenterBaton RougeLA
| | - J. Zabaleta
- Department of Pediatrics and Stanley S. Scott Cancer CenterLouisiana State University Health Sciences CenterNew OrleansLAUSA
| | - M. Sothern
- Department of Pediatrics, School of Medicine and School of Public HealthLouisiana State University Health Sciences CenterNew OrleansLAUSA
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