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Anthony V Damico - One of the best experts on this subject based on the ideXlab platform.

  • external Beam Radiation therapy and brachytherapy boost versus radical prostatectomy and adjuvant Radiation therapy for high risk prostate cancer
    Journal of Clinical Oncology, 2019
    Co-Authors: Vinayak Muralidhar, Anthony V Damico, Brandon A Mahal, David D Yang, Jonathan E Leeman, Paul L Nguyen, Peter F Orio, Martin T King
    Abstract:

    21Background: Previous studies have suggested that combination external Beam Radiation therapy (EBRT) with brachytherapy boost (BT) for high-risk prostate cancer is associated with equivalent overa...

  • short course androgen deprivation therapy and the risk of death from high risk prostate cancer in men undergoing external Beam Radiation therapy and brachytherapy
    Brachytherapy, 2015
    Co-Authors: Ann C Raldow, Danjie Zhang, Minghui Chen, Michelle H Braccioforte, Brian J Moran, Anthony V Damico
    Abstract:

    Abstract Purpose We estimated the risks of prostate cancer–specific mortality (PCSM) and all-cause mortality (ACM) in men with high-risk prostate cancer (PC) undergoing external Beam Radiation therapy and brachytherapy with short-course androgen deprivation therapy (ADT) (median 4 months) as compared with men with more favorable-risk PC undergoing standard of care as per the National Comprehensive Cancer Network guidelines. Methods and Materials The prospective study cohort comprised 6595 consecutively treated men with T1-4 N0M0 PC whose treatment included brachytherapy between October 16, 1997, and May 28, 2013. Fine and Gray competing risk regression and Cox regression analyses were used to assess the risks of PCSM and ACM in men with high, unfavorable intermediate, and favorable intermediate risk as compared with low-risk PC. Results After median followup of 7.76 years, 820 men died (12.43%): 72 of PC (8.78%). Men with favorable intermediate–risk PC did not have significantly increased PCSM risk as compared with men with low-risk PC (adjusted hazard ratio [AHR], 1.26; 95% confidence interval [CI] 0.56, 2.88; p-Value 0.58), whereas men with high-risk PC (AHR, 3.74; 95% CI 1.12, 12.53; p-Value 0.032) and unfavorable intermediate–risk PC (AHR, 3.10; 95% CI 1.43, 6.72; p-Value 0.004) did. Based on 10-year adjusted point estimates of PCSM and ACM for men with high-risk PC being 6.01% (95% CI 3.79%, 8.94%) and 21.30% (95% CI 17.45%, 25.42%), respectively, PCSM comprised 28% of ACM. Conclusions In the setting of external Beam Radiation therapy and brachytherapy, men with high-risk PC have low absolute adjusted estimates of PCSM (∼6%) during the first decade after treatment despite receiving only short-course ADT. Whether long-term ADT can lower PCSM and improve survival in these men requires additional study.

  • pretreatment nomogram for prostate specific antigen recurrence after radical prostatectomy or external Beam Radiation therapy for clinically localized prostate cancer
    Journal of Clinical Oncology, 1999
    Co-Authors: Anthony V Damico, Richard Whittington, Irving D Kaplan, Clair J Beard, Bruce S Malkowicz, Minghui Chen, Julie Fondurulia, John E Tomaszewski, Andrew A Renshaw, Alan J Wein
    Abstract:

    PURPOSE: To present nomograms providing estimates of prostate-specific antigen (PSA) failure–free survival after radical prostatectomy (RP) or external-Beam Radiation therapy (RT) for men diagnosed during the PSA era with clinically localized disease. PATIENTS AND METHODS: A Cox regression multivariable analysis was used to determine the prognostic significance of the pretreatment PSA level, 1992 American Joint Committee on Cancer (AJCC) clinical stage, and biopsy Gleason score in predicting the time to posttherapy PSA failure in 1,654 men with T1c,2 prostate cancer managed with either RP or RT. RESULTS: Pretherapy PSA, AJCC clinical stage, and biopsy Gleason score were independent predictors (P < .0001) of time to posttherapy PSA failure in patients managed with either RP or RT. Two-year PSA failure rates derived from the Cox regression model and bootstrap estimates of the 95% confidence intervals are presented in the format of a nomogram stratified by the pretreatment PSA, AJCC clinical stage, biopsy Gl...

  • equivalent biochemical failure free survival after external Beam Radiation therapy or radical prostatectomy in patients with a pretreatment prostate specific antigen of 4 20 ng ml
    International Journal of Radiation Oncology Biology Physics, 1997
    Co-Authors: Anthony V Damico, Richard Whittington, Irving D Kaplan, Clair J Beard, Michael Jiroutek, Bruce S Malkowicz, Alan J Wein, Norman C Coleman
    Abstract:

    Purpose: Biochemical failure-free survival stratified by the pretreatment prostate-specific antigen (PSA) and biopsyleason score (bG1) is determined for prostate cancer patients managed definitively with external Beam Radiation therapy or radical retropubic prostatectomy. Methods and Materials: A Cox regression multivariable analysis evaluating tbe variables of PSA, bGI, and clinical stage was used to evaluate the end point of time to PSA failure in 867 and 757 consecutive prostate cancer patients managed definitively wltb external Beam Radiation therapy or radical retropubic prostatectomy, respectively. PSA failure-free survival was determined using Kaplan-Meier analysis. Comparisons were made using the log rank test. Results: The pretreatment PSA, bG1, and clinical stage (T3,4 vs. Tl,T2) were found to be independent predictors of to post-treatment PSA failure for both surgically and Radiation managed patients using Cox regression multivariable analysis. Patients with a pretreatment PSA of > 4 rig/ml and 5 20 rig/ml could be classified into risk groups for time to post-therapy PSA failure: low = PSA > 4-10 rig/ml and bG1 -= 4; intermediate = PSA > 4-10 and bG15-7; or PSA > lo-20 rig/ml and bGI 5 7; high = PSA > 4-20 rig/ml and bG1 2 8. Two-year PSA failure-free survival for surgically managed and Radiation-managed patients, respectively, were 98% vs. 92% (p = 0.45), 77% vs. 81% (p = 0.86), and 51% vs. 53% (p = 0.48) for patients at low, intermediate, and high risk for post-therapy PSA failure. Conclusions: There was no statistical difference in tbe 2-year PSA failure-free survival for potentially curable patients managed definitively with surgery or Radiation therapy when a retrospective comparison stratifying for the pretreatment PSA and bG1 was performed. 0 1997 Elsevier Science Inc. Prostate cancer, Prostate-specific antigen, Gleason score, Radiation therapy, Radical prostatectomy.

Gregory S Merrick - One of the best experts on this subject based on the ideXlab platform.

  • american brachytherapy society task group report combination of brachytherapy and external Beam Radiation for high risk prostate cancer
    Brachytherapy, 2017
    Co-Authors: Daniel E Spratt, John C Blasko, Gregory S Merrick, P D Soni, Patrick W Mclaughlin, Richard G Stock, Michael J Zelefsky
    Abstract:

    Abstract Purpose To review outcomes for high-risk prostate cancer treated with combined modality Radiation therapy (CMRT) utilizing external Beam Radiation therapy (EBRT) with a brachytherapy boost. Methods and Materials The available literature for high-risk prostate cancer treated with combined modality Radiation therapy was reviewed and summarized. Results At this time, the literature suggests that the majority of high-risk cancers are curable with multimodal treatment. Several large retrospective studies and three prospective randomized trials comparing CMRT to dose-escalated EBRT have demonstrated superior biochemical control with CMRT. Longer followup of the randomized trials will be required to determine if this will translate to a benefit in metastasis-free survival, disease-specific survival, and overall survival. Although greater toxicity has been associated with CMRT compared to EBRT, recent studies suggest that technological advances that allow better definition and sparing of critical adjacent structures as well as increasing experience with brachytherapy have improved implant quality and the toxicity profile of brachytherapy. The role of androgen deprivation therapy is well established in the external Beam literature for high-risk disease, but there is controversy regarding the applicability of these data in the setting of dose escalation. At this time, there is not sufficient evidence for the omission of androgen deprivation therapy with dose escalation in this population. Comparisons with surgery remain limited by differences in patient selection, but the evidence would suggest better disease control with CMRT compared to surgery alone. Conclusions Due to a series of technological advances, modern combination series have demonstrated unparalleled rates of disease control in the high-risk population. Given the evidence from recent randomized trials, combination therapy may become the standard of care for high-risk cancers.

  • biochemical outcome for hormone naive patients with high risk prostate cancer managed with permanent interstitial brachytherapy and supplemental external Beam Radiation
    Cancer Journal, 2002
    Co-Authors: Gregory S Merrick, Wayne M Butler, Jonathan H Lief, Robert W Galbreath, Edward Adamovich
    Abstract:

    PURPOSE: The purpose of this article is to report the 5-year biochemical disease-free outcome for hormone-naive patients with high-risk disease who underwent permanent prostate brachytherapy. Multiple clinical and treatment parameters were also evaluated to determine whether any of these influence biochemical outcome. MATERIALS AND METHODS: Sixty-six hormone-naive patients underwent transperineal ultrasound-guided permanent prostate brachytherapy with generous periprostatic margins by use of either 103Pd or 125I for high-risk prostate cancer from April 1995 to October 1999. High-risk patients presented with two or three of the following risk factors: Gleason score > or = 7, prostate-specific antigen > or = 10 ng/mL, and clinical stage > or = T2b, 1997 AJCC. No patient underwent pathological lymph node staging. Only one patient was implanted with monotherapy, whereas 65 patients received supplemental external-Beam Radiation therapy before a prostate brachytherapy boost. The median patient age was 69 years (range, 50-81 years). No patient was lost to follow-up. The mean follow-up and median follow-up were 53.2 +/- 14.9 months and 53.7 months, respectively (range, 19.8-79.7 months). Follow-up was calculated from the day of implantation. Biochemical disease-free survival was defined by the American Society of Therapeutic Radiology and Oncology consensus definition. Clinical parameters evaluated for biochemical disease-free survival included patient age, clinical stage, Gleason score, and pretreatment prostate-specific antigen. Treatment parameters included use of supplemental external-Beam Radiation therapy and choice of isotope. RESULTS: The 5-year actuarial biochemical disease-free survival rate was 79.9%. In multivariate analysis, preimplantation prostate-specific antigen (P = 0.008) was the only clinical or treatment parameter that predicted for biochemical failure. The mean and median posttreatment prostate-specific antigen levels were 0.13 +/- 0.22 ng/mL and < 0.1 ng/mL, respectively. DISCUSSION: At a median follow-up of 53.7 months, hormone-naive patients with high-risk disease who undergo permanent prostate brachytherapy have a high probability of 5-year biochemical disease-free survival and an apparent plateau on the biochemical disease-free survival curve.

  • biochemical outcome for hormone naive intermediate risk prostate cancer managed with permanent interstitial brachytherapy and supplemental external Beam Radiation
    Brachytherapy, 2002
    Co-Authors: Gregory S Merrick, Wayne M Butler, Jonathan H Lief, Robert W Galbreath, Edward Adamovich
    Abstract:

    Purpose: To report the 6-year biochemical disease-free outcome for hormone-naive patients with intermediate-risk disease (Gleason score ≥7, prostate-specific antigen (PSA) ≥10 ng/ml, or clinical stage ≥T2b [1997 American Joint Committee on Cancer]) undergoing brachytherapy with supplemental external Beam Radiation (XRT). Methods and Materials: Seventy-seven consecutive hormone-naive intermediate-risk prostate cancer patients received supplemental XRT followed by a brachytherapy boost. No patient underwent pathologic lymph node staging. The median patient age was 69 years and the median follow-up was 52 months. Biochemical disease-free survival was defined by the American Society of Therapeutic Radiology and Oncology consensus definition. Clinical and treatment parameters evaluated included patient age, clinical stage, Gleason score, pretreatment PSA, and isotope. Results: The 6-year actuarial biochemical no-evidence-of-disease survival rate was 97.4%. None of the evaluated clinical or treatment parameters, except for a Gleason score ≥8, predicted for failure. The mean and median posttreatment PSA was 0.08 ± 0.19 ng/ml and <0.1 ng/ml, respectively. When stratified by isotope, the mean posttreatment PSA was not significantly different (0.07 ± 0.11 ng/ml for 103Pd vs. 0.14 ± 0.32 ng/ml for 125I; p = 0.397). Conclusions: Hormone-naive intermediate-risk prostate cancer patients undergoing brachytherapy with supplemental XRT have a high probability of 6-year biochemical disease-free survival. None of the evaluated clinical or treatment parameters, except Gleason score ≥8, predicted for treatment failure.

Felipe A Calvo - One of the best experts on this subject based on the ideXlab platform.

  • prognostic value of external Beam Radiation therapy in patients treated with surgical resection and intraoperative electron Beam Radiation therapy for locally recurrent soft tissue sarcoma a multicentric long term outcome analysis
    International Journal of Radiation Oncology Biology Physics, 2014
    Co-Authors: Felipe A Calvo, Claudio V Sole, Mauricio Cambeiro, A Montero, A Polo, C Gonzalez, Miguel Cuervo, Mikel San Julian
    Abstract:

    Background A joint analysis of data from centers involved in the Spanish Cooperative Initiative for Intraoperative Electron Radiotherapy was performed to investigate long-term outcomes of locally recurrent soft tissue sarcoma (LR-STS) patients treated with a multidisciplinary approach. Methods and Materials Patients with a histologic diagnosis of LR-STS (extremity, 43%; trunk wall, 24%; retroperitoneum, 33%) and no distant metastases who underwent radical surgery and intraoperative electron Radiation therapy (IOERT; median dose, 12.5 Gy) were considered eligible for participation in this study. In addition, 62% received external Beam Radiation therapy (EBRT; median dose, 50 Gy). Results From 1986 to 2012, a total of 103 patients from 3 Spanish expert IOERT institutions were analyzed. With a median follow-up of 57 months (range, 2-311 months), 5-year local control (LC) was 60%. The 5-year IORT in-field control, disease-free survival (DFS), and overall survival were 73%, 43%, and 52%, respectively. In the multivariate analysis, no EBRT to treat the LR-STS ( P =.02) and microscopically involved margin resection status ( P =.04) retained significance in relation to LC. With regard to IORT in-field control, only not delivering EBRT to the LR-STS retained significance in the multivariate analysis ( P =.03). Conclusion This joint analysis revealed that surgical margin and EBRT affect LC but that, given the high risk of distant metastases, DFS remains modest. Intensified local treatment needs to be further tested in the context of more efficient concurrent, neoadjuvant, and adjuvant systemic therapy.

  • prognostic impact of external Beam Radiation therapy in patients treated with and without extended surgery and intraoperative electrons for locally recurrent rectal cancer 16 year experience in a single institution
    International Journal of Radiation Oncology Biology Physics, 2013
    Co-Authors: Felipe A Calvo, Claudio V Sole, Pedro Alvarez De Sierra, M Gomezespi, Jose Blanco, M A Lozano, Emilio Del Valle, Marcos Rodriguez
    Abstract:

    Purpose To analyze prognostic factors associated with survival in patients after intraoperative electrons containing resective surgical rescue of locally recurrent rectal cancer (LRRC). Methods and Materials From January 1995 to December 2011, 60 patients with LRRC underwent extended surgery (n=38: multiorgan [43%], bone [28%], soft tissue [38%]) or nonextended (n=22) surgical resection, including a component of intraoperative electron-Beam Radiation therapy (IOERT) to the pelvic recurrence tumor bed. Twenty-eight (47%) of these patients also received external Beam Radiation therapy (EBRT) (range, 30.6-50.4 Gy). Survival outcomes were estimated by the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results The median follow-up time was 36 months (range, 2-189 months), and the 1-year, 3-year, and 5-year rates for locoregional control (LRC) and overall survival (OS) were 86%, 52%, and 44%; and 78%, 53%, 43%, respectively. On multivariate analysis, R1 resection, EBRT at the time of pelvic rerecurrence, no tumor fragmentation, and non-lymph node metastasis retained significance with regard to LRR. R1 resection and no tumor fragmentation showed a significant association with OS after adjustment for other covariates. Conclusions EBRT treatment integrated for rescue, resection radicality, and not involved fragmented resection specimens are associated with improved LRC in patients with locally recurrent rectal cancer. Additionally, tumor fragmentation could be compensated by EBRT. Present results suggest that a significant group of patients with LRRC may benefit from EBRT treatment integrated with extended surgery and IOERT.

Edward Adamovich - One of the best experts on this subject based on the ideXlab platform.

  • biochemical outcome for hormone naive patients with high risk prostate cancer managed with permanent interstitial brachytherapy and supplemental external Beam Radiation
    Cancer Journal, 2002
    Co-Authors: Gregory S Merrick, Wayne M Butler, Jonathan H Lief, Robert W Galbreath, Edward Adamovich
    Abstract:

    PURPOSE: The purpose of this article is to report the 5-year biochemical disease-free outcome for hormone-naive patients with high-risk disease who underwent permanent prostate brachytherapy. Multiple clinical and treatment parameters were also evaluated to determine whether any of these influence biochemical outcome. MATERIALS AND METHODS: Sixty-six hormone-naive patients underwent transperineal ultrasound-guided permanent prostate brachytherapy with generous periprostatic margins by use of either 103Pd or 125I for high-risk prostate cancer from April 1995 to October 1999. High-risk patients presented with two or three of the following risk factors: Gleason score > or = 7, prostate-specific antigen > or = 10 ng/mL, and clinical stage > or = T2b, 1997 AJCC. No patient underwent pathological lymph node staging. Only one patient was implanted with monotherapy, whereas 65 patients received supplemental external-Beam Radiation therapy before a prostate brachytherapy boost. The median patient age was 69 years (range, 50-81 years). No patient was lost to follow-up. The mean follow-up and median follow-up were 53.2 +/- 14.9 months and 53.7 months, respectively (range, 19.8-79.7 months). Follow-up was calculated from the day of implantation. Biochemical disease-free survival was defined by the American Society of Therapeutic Radiology and Oncology consensus definition. Clinical parameters evaluated for biochemical disease-free survival included patient age, clinical stage, Gleason score, and pretreatment prostate-specific antigen. Treatment parameters included use of supplemental external-Beam Radiation therapy and choice of isotope. RESULTS: The 5-year actuarial biochemical disease-free survival rate was 79.9%. In multivariate analysis, preimplantation prostate-specific antigen (P = 0.008) was the only clinical or treatment parameter that predicted for biochemical failure. The mean and median posttreatment prostate-specific antigen levels were 0.13 +/- 0.22 ng/mL and < 0.1 ng/mL, respectively. DISCUSSION: At a median follow-up of 53.7 months, hormone-naive patients with high-risk disease who undergo permanent prostate brachytherapy have a high probability of 5-year biochemical disease-free survival and an apparent plateau on the biochemical disease-free survival curve.

  • biochemical outcome for hormone naive intermediate risk prostate cancer managed with permanent interstitial brachytherapy and supplemental external Beam Radiation
    Brachytherapy, 2002
    Co-Authors: Gregory S Merrick, Wayne M Butler, Jonathan H Lief, Robert W Galbreath, Edward Adamovich
    Abstract:

    Purpose: To report the 6-year biochemical disease-free outcome for hormone-naive patients with intermediate-risk disease (Gleason score ≥7, prostate-specific antigen (PSA) ≥10 ng/ml, or clinical stage ≥T2b [1997 American Joint Committee on Cancer]) undergoing brachytherapy with supplemental external Beam Radiation (XRT). Methods and Materials: Seventy-seven consecutive hormone-naive intermediate-risk prostate cancer patients received supplemental XRT followed by a brachytherapy boost. No patient underwent pathologic lymph node staging. The median patient age was 69 years and the median follow-up was 52 months. Biochemical disease-free survival was defined by the American Society of Therapeutic Radiology and Oncology consensus definition. Clinical and treatment parameters evaluated included patient age, clinical stage, Gleason score, pretreatment PSA, and isotope. Results: The 6-year actuarial biochemical no-evidence-of-disease survival rate was 97.4%. None of the evaluated clinical or treatment parameters, except for a Gleason score ≥8, predicted for failure. The mean and median posttreatment PSA was 0.08 ± 0.19 ng/ml and <0.1 ng/ml, respectively. When stratified by isotope, the mean posttreatment PSA was not significantly different (0.07 ± 0.11 ng/ml for 103Pd vs. 0.14 ± 0.32 ng/ml for 125I; p = 0.397). Conclusions: Hormone-naive intermediate-risk prostate cancer patients undergoing brachytherapy with supplemental XRT have a high probability of 6-year biochemical disease-free survival. None of the evaluated clinical or treatment parameters, except Gleason score ≥8, predicted for treatment failure.

Howard M Sandler - One of the best experts on this subject based on the ideXlab platform.

  • confirmation of a low α β ratio for prostate cancer treated by external Beam Radiation therapy alone using a post treatment repeated measures model for psa dynamics
    International Journal of Radiation Oncology Biology Physics, 2011
    Co-Authors: Cecile Proustlima, Howard M Sandler, Jeremy M G Taylor, Solene Secher, Larry L Kestin, Tom Pickles, K Bae, Roger Allison, Scott Williams
    Abstract:

    Purpose To estimate the α/β ratio of prostate cancer treated with external Beam Radiation only by use of a model of long-term prostate-specific antigen (PSA) dynamics. Methods and Materials Repeated measures of PSA from 5,093 patients from 6 institutions treated for localized prostate cancer by external Beam Radiation therapy (EBRT) without planned androgen deprivation were analyzed. A biphasic linear mixed model described the post-treatment evolution of PSA, rather than a conventional model of time to biochemical recurrence. The model was adjusted for standard prognostic factors (T stage, initial PSA level, and Gleason score) and cohort-specific effects. The Radiation dose fractionation effect was estimated from the long-term rate of rise of PSA level. Results Adjusted for other factors, total dose of EBRT and sum of squared doses per fraction were associated with long-term rate of change of PSA level ( p = 0.0017 and p = 0.0003, respectively), an increase of each being associated with a lower rate of rise. The α/β ratio was estimated at 1.55 Gy (95% confidence band, 0.46–4.52 Gy). This estimate was robust to adjustment of the linear mixed model. Conclusions By analysis of a large EBRT-only cohort along with a method that uses all the repeated measures of PSA after the end of treatment, a low and precise α/β was estimated. These data support the use of hypofractionation at fractional doses up to 2.8 Gy but cannot presently be assumed to accurately represent higher doses per fraction.

  • long term results of an rtog phase ii trial 00 19 of external Beam Radiation therapy combined with permanent source brachytherapy for intermediate risk clinically localized adenocarcinoma of the prostate
    International Journal of Radiation Oncology Biology Physics, 2010
    Co-Authors: Colleen A Lawton, Michael Gillin, S Firat, Madhava Baikadi, Juanita Crook, Michael Kuettel, Gerald Morton, Howard M Sandler
    Abstract:

    Purpose External-Beam Radiation therapy combined with low—doserate permanent brachytherapy are commonly used to treat men with localized prostate cancer. This Phase II trial was performed to document late gastrointestinal or genitourinary toxicity as well as biochemical control for this treatment in a multi-institutional cooperative group setting. This report defines the long-term results of this trial. Methods and Materials All eligible patients received external-Beam Radiation (45 Gy in 25 fractions) followed 2–6 weeks later by a permanent iodine 125 implant of 108 Gy. Late toxicity was defined by the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late Radiation morbidity scoring scheme. Biochemical control was defined by the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus definition and the ASTRO Phoenix definition. Results One hundred thirty-eight patients were enrolled from 20 institutions, and 131 were eligible. Median follow-up (living patients) was 8.2 years (range, 2.7–9.3 years). The 8-year estimate of late grade >3 genitourinary and/or gastrointestinal toxicity was 15%. The most common grade >3 toxicities were urinary frequency, dysuria, and proctitis. There were two grade 4 toxicities, both bladder necrosis, and no grade 5 toxicities. In addition, 42% of patients complained of grade 3 impotence (no erections) at 8 years. The 8-year estimate of biochemical failure was 18% and 21% by the Phoenix and ASTRO consensus definitions, respectively. Conclusion Biochemical control for this treatment seems durable with 8 years of follow-up and is similar to high—dose external Beam Radiation alone or brachytherapy alone. Late toxicity in this multi-institutional trial is higher than reports from similar cohorts of patients treated with high—dose external-Beam Radiation alone or permanent low—doserate brachytherapy alone, perhaps suggesting further attention to strategies that limit doses to normal structures or to unimodal radiotherapy techniques.

  • biochemical and clinical significance of the posttreatment prostate specific antigen bounce for prostate cancer patients treated with external Beam Radiation therapy alone a multiinstitutional pooled analysis
    Cancer, 2006
    Co-Authors: Eric M Horwitz, Howard D Thames, Larry B Levy, Patrick A Kupelian, Alvaro Martinez, Jeff M Michalski, Thomas M Pisansky, Howard M Sandler, William U Shipley, Michael J Zelefsky
    Abstract:

    BACKGROUND. The posttreatment prostate-specific antigen (PSA) bounce phenomenon has been recognized in at least 20% of all patients treated with Radiation. The purpose of the current report was to determine if there was a difference in biochemical and clinical control between the bounce and nonbounce (NB) patients using pooled data on 4839 patients with T1-2 prostate cancer treated with external Beam Radiation therapy (RT) alone at 9 institutions between 1986 and 1995. METHODS. The median follow-up was 6.3 years. A posttreatment PSA bounce was defined by a minimal rise of 0.4 ng/mL over a 6-month follow-up period, followed by a drop in PSA level of any magnitude. Endpoints included no biochemical evidence of disease (bNED) failure (BF) (ASTRO definition), distant failure (DF), cause-specific failure (CSF), and overall survival (OS). Patients were stratified by pretreatment PSA, Gleason score, T stage, age, dose, and risk group. RESULTS. In all, 978 (20%) patients experienced at least 1 posttreatment PSA bounce. Within 3 subgroups (risk group, pretreatment PSA, and age), statistically significant differences of remaining bounce-free were observed on univariate analysis. Patients < 70 years had a 72% chance of remaining bounce-free at 5 years compared with 75% for older patients (P ¼.04). The NB patients had 72% bNED control at 10 years compared with 58% for the bounce patients. The effect of a bounce remained statistically significant on multivariate analysis (P < .0001). No statistically significant difference in DF, CSF, or OS was observed. CONCLUSIONS. Patients treated with external Beam Radiation therapy alone who experience a posttreatment PSA bounce have increased risk of BF. However, this did not translate into a difference in clinical failure with the available follow-up in the current study. Cancer 2006;107:1496–502. � 2006 American Cancer Society.

  • definitions of biochemical failure that best predict clinical failure in patients with prostate cancer treated with external Beam Radiation alone a multi institutional pooled analysis
    The Journal of Urology, 2005
    Co-Authors: Eric M Horwitz, Howard D Thames, Deborah A Kuban, Larry B Levy, Patrick A Kupelian, Alvaro Martinez, Jeff M Michalski, Thomas M Pisansky, Howard M Sandler, William U Shipley
    Abstract:

    ABSTRACTPurpose: Pooled data on 4,839 patients with T1-2 prostate cancer treated with external Beam Radiation therapy (RT) alone at 9 institutions have previously provided long-term biochemical fai...