Actuarial Distant Metastasis-free Survival Research Articles

The Impact of Regional Nodal Irradiation on the Outcomes After Neoadjuvant Chemotherapy in Node Positive Breast Cancer Patients With ypN0: Interim Analysis of a Prospective Randomized Trial

To evaluate the impact of regional nodal irradiation (RNI) on the loco-regional recurrence free survival (LRFS), distant metastases free survival (DMFS) and overall survival (OS) in breast cancer patients with node positive disease who received neoadjuvant chemotherapy (NAC) and became ypN0.From January 1st 2016 till December 31st 2019, 231 patients with node positive breast cancer who received NAC and became ypN0 were randomized to receive whole breast irradiation/post mastectomy irradiation with or without RNI. One hundred and twelve patients were included in the regional nodal irradiation arm (RNI+) and 119 patients were included in the no regional nodal irradiation arm (RNI-).Median follow up was 24 months (range, 1-55 months). No regional nodal failures were recorded in both groups. The actuarial LRFS was 98.2% in the RNI+ arm and 100% in the RNI- arm (P 0.28). The actuarial DMFS was 93.6% in the RNI+ arm and 97.4% in the RNI- arm (P 0.93). The actuarial OS was 96.3% in the RNI+ arm and 99.1% in the RNI- arm (P 0.75). Cox univariate regression analysis revealed initial tumor size > 5 cm (HR 1.276, CI 1.054-1.543, P 0.012) was the only factor associated with increased incidence of distant metastases. Age younger than 35 years was associated with worsened survival (HR 0.866, CI 0.760-0.986, P 0.03).In the current interim analysis, omission of regional nodal irradiation did not compromise the outcomes in clinically node positive patients who received NAC and had ypN0 disease.

Stereotactic body radiation therapy for low and intermediate risk prostate cancer—Results from a multi-institutional clinical trial

BackgroundWe report the outcome of a phase I/II clinical trial of stereotactic body radiation therapy (SBRT) for low (LR) and select intermediate risk (IR) prostate cancer (PCa) patients. Patients and methodsEligible patients included men with prostate adenocarcinoma with Gleason score 6 with PSA ≤ 20 or Gleason 7 with PSA ≤ 15 and clinical stage ≤ T2b. For the phase I portion of the study patients in cohorts of 15 received 45, 47.5, or 50 Gray (Gy) in five fractions. Since the maximally tolerated dose was not met in the phase I study, an additional 47 patients received 50 Gy in five fractions in the phase II study. Toxicity using Common Toxicity Criteria for Adverse Events v. 3.0, quality of life, and outcome data was collected. ResultsA total of 91 patients are included for analysis; 63.7% had NCCN IR and 36.3% had LR PCa. At a median follow up of 54 months the actuarial freedom from biochemical failure was 100% at 3 years and 98.6% at 5 years. Actuarial distant metastasis free survival was 100% at 3 and 5 years. Overall survival was 94% at 3 years and 89.7% at 5 years with no deaths attributed to PCa. Acute and late urinary grade ≥ III toxicity occurred in 0% and 5.5% of patients, respectively. Gastrointestinal (GI) acute and late toxicity of grade ≥ III occurred in 2% and 7% of patients, respectively. A total of four men experienced grade IV toxicity (three GI, one genitourinary). ConclusionSBRT treatment results in excellent biochemical control rates at 5 years for LR and IR PCa patients although doses greater than 47.5 Gy in five fractions led to increased severe late toxicity.

Delaying conformal radiation therapy in high-risk prostate cancer patients lowers the actuarial distant metastases free survival

15614 Background: It is not well documented on medical literature the value of time to treat prostate cancer. This study was performed to evaluate the value of treatment time with conformal radiotherapy (3DCRT) in high-risk prostate cancer patients. Methods: From October 1997 to January 2002, 116 patients with high-risk prostate cancer were submitted to 3DCRT and were analyzed retrospectively. The median age was 65 years-old. High risk patients were defined as patients with PSA > 20 ng/ml, and/or T3 clinical stage and/or Gleason score > 7, or two factors of intermediate risk (PSA >= 10 and < 20 ng/ml, T2b-T2c and Gleason score = 7). The median time from diagnosis to 3DCRT was 2.9 months (0.9–134.9). The median doses of radiation on prostate and on seminal vesicles were 81 Gy (72–82.8) and 61.2 Gy (45–77.4), respectively. The neoadjuvant and concomitant androgen suppression therapy were performed on 69 (59.5%) and 79 (68.1%) patients, respectively. Results: On median follow-up of 54.5 months (13.5–93.9), the 5-year actuarial overall survival, the 5-year actuarial biochemical progression-free survival and the 5-year actuarial distant metastases free survival were 84.3%, 64.7% and 88.6%, respectively. The 5-year actuarial distant metastases free survival for patients treated with 3DCRT less than or equal to 5 months was 92.5% versus 72.1% for patients treated with 3DCRT > 5 months (p=0.0076). The 5-year actuarial distant metastases free survival for patients with biochemichal progression was 68.8% versus 100% for patients with no biochemical progression (p 65 years-old (p=0.0160). Conclusions: The study suggests that delaying 3DCRT in high-risk prostate cancer patients lowers the actuarial distant metastases free survival. Biochemical progression may be a strong prognostic factor for distant metastases and, consequently, poor quality of life. No significant financial relationships to disclose.

Predictors of survival for prostate carcinoma patients treated with salvage radical prostatectomy after radiation therapy.

Salvage radical prostatectomy is a treatment option for patients with recurrent cancer following radiation therapy. This study was conducted to identify predictors of survival for patients treated with salvage radical prostatectomy. The authors studied 86 prostate carcinoma patients who underwent salvage radical prostatectomy for locally persistent or recurrent prostate carcinoma at Mayo Clinic between 1967 and 1996. The mean interval from radiation therapy to biopsy-proven recurrence was 3.7 years (range, 6 months to 17 years). Patient age at surgery ranged from 51 to 78 years (median, 66 years). The mean follow-up after surgery was 5.8 years (range, 1.0-15.2 years). Cox proportional hazards models were used to identify clinical and pathologic factors associated with distant metastasis free survival and cancer specific survival. Actuarial distant metastasis free survival, cancer specific survival, and overall survival were 83%, 91%, and 85% at 5 years and 69%, 64%, and 54% at 10 years, respectively. In multivariate analysis, radical prostatectomy Gleason score and DNA ploidy were independent predictors of distant metastasis free survival and cancer specific survival. Postirradiation Gleason score and DNA ploidy were highly predictive of the clinical outcomes of patients treated by salvage radical prostatectomy after radiation therapy.

The effect of local control on metastatic dissemination in carcinoma of the prostate: Long-term results in patients treated with 1251 implantation

The study evaluates the effect of the locally recurring tumor on the incidence of metastatic disease in early stage carcinoma of the prostate. The probability of distant metastases was studied in 679 patients with Stage B-C/NO carcinoma of the prostate treated at MSKCC between 1970 and 1985 (median follow-up of 97 months). Patients were staged with pelvic lymph node dissection and treated with retropubic 125I implantation. The actuarial distant metastases free survival (DMFS) for patients at risk at 15 years after initial therapy was 37%. Cox proportional hazard regression analysis of covariates affecting the metastatic outcome showed that local failure, used in the model as a time dependent variable, was the most significant covariate, although stage, grade, and implant volume were also found to be independent variables. The relative risk of metastatic spread subsequent to local failure was 4-fold increased compared to the risk without evidence of local relapse. The 15-year actuarial DMFS in 351 patients with local control was 77% compared to 24% in 328 patients who developed local relapses ( p < 0.00001). The relation of distant spread to the local outcome was observed regardless of stage, grade, or implant dose. Even stage BI/NO-Grade I patient with local control showed a 15-year actuarial DMFS of 82%, compared to 22% in patients with local relapse; p < 0.00001). The median local relapse-free survival (LRFS) in the 268 patients with local recurrences who did not receive hormonal therapy before distant metastases were detected was 51 months, compared to a median of 71 months for DMFS in the same patients ( p < 0.001), consistent with the possibility that distant dissemination may develop secondary to local failure. Furthermore, distant metastases in patients with local control, apparently already existing as micrometastases before treatment, were detected earlier (median DMFS of 37 months) than in patients with local relapse (median DMFS of 54 months; p = 0.009). These data suggest that the existence and re-growth of local residual disease in localized prostatic carcinoma promotes an enhanced spread of metastatic disease, and that early and complete eradication of the primary tumor is required if a long term cure is to be achieved, although the clinical expression of secondary metastases may not become apparent for 6.5 years or more in one-half of the patients.