A Systematic Review and Meta-analysis of Local Salvage Therapies After Radiotherapy for Prostate Cancer (MASTER)

Published on Sep 1, 2021in European Urology20.096
· DOI :10.1016/J.EURURO.2020.11.010
Luca F. Valle8
Estimated H-index: 8
(UCLA: University of California, Los Angeles),
Eric J. Lehrer15
Estimated H-index: 15
(ISMMS: Icahn School of Medicine at Mount Sinai)
+ 14 AuthorsAmar U. Kishan22
Estimated H-index: 22
(UCLA: University of California, Los Angeles)
Abstract Context Management of locally recurrent prostate cancer after definitive radiotherapy remains controversial due to the perceived high rates of severe genitourinary (GU) and gastrointestinal (GI) toxicity associated with any local salvage modality. Objective To quantitatively compare the efficacy and toxicity of salvage radical prostatectomy (RP), high-intensity focused ultrasound (HIFU), cryotherapy, stereotactic body radiotherapy (SBRT), low–dose-rate (LDR) brachytherapy, and high-dose-rate (HDR) brachytherapy. Evidence acquisition We performed a systematic review of PubMed, EMBASE, and MEDLINE. Two- and 5-yr recurrence-free survival (RFS) rates and crude incidences of severe GU and GI toxicity were extracted as endpoints of interest. Random-effect meta-analyses were conducted to characterize summary effect sizes and quantify heterogeneity. Estimates for each modality were then compared with RP after adjusting for individual study-level covariates using mixed-effect regression models, while allowing for differences in between-study variance across treatment modalities. Evidence synthesis A total of 150 studies were included for analysis. There was significant heterogeneity between studies within each modality, and covariates differed between modalities, necessitating adjustment. Adjusted 5-yr RFS ranged from 50% after cryotherapy to 60% after HDR brachytherapy and SBRT, with no significant differences between any modality and RP. Severe GU toxicity was significantly lower with all three forms of radiotherapeutic salvage than with RP (adjusted rates of 20% after RP vs 5.6%, 9.6%, and 9.1% after SBRT, HDR brachytherapy, and LDR brachytherapy, respectively; p ≤ 0.001 for all). Severe GI toxicity was significantly lower with HDR salvage than with RP (adjusted rates 1.8% vs 0.0%, p  Conclusions Large differences in 5-yr outcomes were not uncovered when comparing all salvage treatment modalities against RP. Reirradiation with SBRT, HDR brachytherapy, or LDR brachytherapy appears to result in less severe GU toxicity than RP, and reirradiation with HDR brachytherapy yields less severe GI toxicity than RP. Prospective studies of local salvage for radiorecurrent disease are warranted. Patient summary In a large study-level meta-analysis, we looked at treatment outcomes and toxicity for men treated with a number of salvage treatments for radiorecurrent prostate cancer. We conclude that relapse-free survival at 5 years is equivalent among salvage modalities, but reirradiation may lead to lower toxicity.
#1Akira YokomizoH-Index: 40
#2Masashi WakabayashiH-Index: 14
Last. Jcog InvestigatorsH-Index: 1
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Abstract Background No standard therapy has been established for localised prostate cancer patients with prostate-specific antigen (PSA) failure after radical prostatectomy (RP). Objective To determine whether radiotherapy ± hormone therapy is superior to hormone therapy alone in such patients. Design, setting, and participants This study is a multicentre, randomised, open-label, phase 3 trial. Patients with localised prostate cancer whose PSA concentrations had decreased to Outcome measurements...
#1Raj Singh (VCU: Virginia Commonwealth University)H-Index: 5
#2Eric J. Lehrer (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 15
Last. Daniel M. Trifiletti (Mayo Clinic)H-Index: 21
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Abstract Background and purpose To perform a systematic review/meta-analysis of outcomes for patients with spinal metastases treated with stereotactic radiosurgery (SRS) (either single-fraction (SF-SRS) or multiple-fraction (MF-SRS)) or conventional radiotherapy (RT). Materials and methods Thirty-seven studies were identified. Primary outcomes were 1-year local control (LC) and acute/late grade 3–5 toxicities (including vertebral compression fractures (VCF)). Weighted random effects meta-analyse...
#1Robert T. Dess (UM: University of Michigan)H-Index: 18
#2Yilun Sun (UM: University of Michigan)H-Index: 11
Last. Daniel E. Spratt (UM: University of Michigan)H-Index: 52
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Importance In men with recurrent prostate cancer, addition of long-term antiandrogen therapy to salvage radiotherapy (SRT) was associated with overall survival (OS) in the NRG/RTOG 9601 study. However, hormone therapy has associated morbidity, and there are no validated predictive biomarkers to identify which patients derive most benefit from treatment. Objective To examine the role of pre-SRT prostate-specific antigen (PSA) levels to personalize hormone therapy use with SRT. Interventions Men w...
#1Gianluca Ingrosso (University of Rome Tor Vergata)H-Index: 15
#2Carlotta Becherini (UniFI: University of Florence)H-Index: 11
Last. Beatrice Detti (UniFI: University of Florence)H-Index: 21
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Abstract Context Different nonsurgical therapeutic strategies can be adopted for intraprostatic relapse of prostate cancer after primary radiotherapy, including re-irradiation (with brachytherapy [BT] or external beam radiotherapy [EBRT]), high-intensity focused ultrasound (HIFU), and cryotherapy. The main issues to consider when choosing nonsurgical salvage local therapies are local tumor control and significant genitourinary toxicity. Objective To conduct a systematic review and meta-analysis ...
#1Thomas Van den Broeck (Katholieke Universiteit Leuven)H-Index: 22
Last. Nicolas MottetH-Index: 39
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Abstract Biochemical recurrence (BCR) after primary treatment of localized prostate cancer does not necessarily lead to clinically apparent progressive disease. To aid in prognostication, the European Association of Urology prostate cancer guidelines panel undertook a systematic review and successfully developed a novel BCR risk stratification system (groups with a low risk or high risk of BCR) based on disease and prostate-specific antigen characteristics. Patient summary Following treatment to...
#1Amar U. Kishan (UCLA: University of California, Los Angeles)H-Index: 22
#2Fang-I Chu (UCLA: University of California, Los Angeles)H-Index: 10
Last. Howard M. Sandler (Cedars-Sinai Medical Center)H-Index: 98
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Abstract Background The importance of local failure (LF) after treatment of high-grade prostate cancer (PCa) with definitive radiotherapy (RT) remains unknown. Objective To evaluate the clinical implications of LF after definitive RT. Design, setting, and participants Individual patient data meta-analysis of 992 patients (593 Gleason grade group [GG] 4 and 399 GG 5) enrolled in six randomized clinical trials. Outcome measurements and statistical analysis Multivariable Cox proportional hazard mod...
Abstract Purpose /Objectives: We evaluated the use of HDR-like stereotactic body radiation therapy (SBRT) retreatment for biopsy proven local persistence in the prostate post-radiotherapy (RT), evaluating efficacy and toxicity. Methods and Materials From 2009–2018, 50 patients with biopsy-proven recurrent prostate cancer >2 years after prior treatment were retreated with an HDR-like dose of 3400 cGy over 5 fractions. Previous radiotherapy dose measured 75.6 Gy (64.8–81.0) and median salvage inte...
#1Ida Sonni (UCLA: University of California, Los Angeles)H-Index: 9
#2Matthias Eiber (TUM: Technische Universität München)H-Index: 24
Last. Jeremie Calais (UCLA: University of California, Los Angeles)H-Index: 23
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The impact of prostate specific membrane antigen (PSMA) PET/CT on management of prostate cancer (PCa) patients with biochemical recurrence (BCR) is well-established. However, whether and how PSMA PET/CT affects the management of patients undergoing scans for other clinical indications remains unknown. The goal of this study was to determine the impact of (68)Ga-PSMA-11 PET/CT on initial and subsequent management decisions in a cohort of PCa patients referred for various indications ("basket tria...
#1Christian Carrie (University of Lyon)H-Index: 50
#2Nicolas MagnéH-Index: 53
Last. Sylvie ChabaudH-Index: 27
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Summary Background Radiotherapy is the standard salvage treatment after radical prostatectomy. To date, the role of androgen deprivation therapy has not been formally shown. In this follow-up study, we aimed to update the results of the GETUG-AFU 16 trial, which assessed the efficacy of radiotherapy plus androgen suppression versus radiotherapy alone. Methods GETUG-AFU 16 was an open-label, multicentre, phase 3, randomised, controlled trial that enrolled men (aged ≥18 years) with Eastern Coopera...
#1David Pasquier (university of lille)H-Index: 22
#2Geoffrey MartinageH-Index: 4
Last. Eric Lartigau (university of lille)H-Index: 36
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Purpose To assess the efficacy and safety of salvage stereotactic body radiation therapy (SBRT) in patients with biopsy-proven local prostate cancer recurrence after radiation therapy. Methods and Materials Between April 2010 and January 2017, 100 patients were included in 7 centers. Disease extension was assessed by pelvic multiparametric magnetic resonance imaging and choline positron emission tomography in 87% and 94% of patients, respectively. The median time interval between the 2 treatment...
Cited By21
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#1Shuhua Wei (PKU: Peking University)H-Index: 4
#2Chunxiao Li (PKU: Peking University)H-Index: 5
Last. Junjie Wang (PKU: Peking University)H-Index: 20
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Radioactive iodine-125 (I-125) is the most widely used radioactive sealed source for interstitial permanent brachytherapy (BT). BT has the exceptional ability to deliver extremely high doses that external beam radiotherapy (EBRT) could never achieve within treated lesions, with the added benefit that doses drop off rapidly outside the target lesion by minimizing the exposure of uninvolved surrounding normal tissue. Spurred by multiple biological and technological advances, BT application has exp...
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OBJECTIVES To report clinical and functional outcomes for patients who have undergone salvage robot-assisted seminal vesicle excision (RA-SVE) for the focal treatment of isolated seminal vesical (SV) recurrence after treatment for prostate cancer by low-dose-rate brachytherapy. PATIENTS AND METHODS Patients with rising prostate-specific antigen (PSA) after low-dose-rate prostate brachytherapy (LDR-PB) underwent multi-parametric magnetic resonance imaging (mp-MRI) of the prostate and 11 C-Choline...
#1Umberto MaestroniH-Index: 12
#2Alessandro Tafuri (University of Verona)H-Index: 15
Last. Francesco ZiglioliH-Index: 6
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Introduction null External Beam Radiation Therapy (EBRT) is one of the option available for the treatment of clinically localized prostate cancer. In patients with radiorecurrent localized prostate cancer, Androgen Deprivation Therapy (ADT) is one of the most common therapeutic strategies. However, in the last decades, other salvage treatment options have been investigated, such as brachytherapy, cryoablation and High Intensity Focused Ultrasound (Hifu). null Material and methods null The oncolo...
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