Ana Alvarez

High-dose radiotherapy with short-term or long-term androgen deprivation in localised prostate cancer (DART01/05 GICOR): a randomised, controlled, phase 3 trial

BACKGROUND The optimum duration of androgen deprivation combined with high-dose radiotherapy in prostate cancer remains undefined. We aimed to determine whether long-term androgen deprivation was superior to short-term androgen deprivation when combined with high-dose radiotherapy. METHODS In this open-label, multicentre, phase 3 randomised controlled trial, patients were recruited from ten university hospitals throughout Spain. Eligible patients had clinical stage T1c-T3b N0M0 prostate adenocarcinoma with intermediate-risk and high-risk factors according to 2005 National Comprehensive Cancer Network criteria. Patients were randomly assigned (1:1) using a computer-generated randomisation schedule to receive either 4 months of androgen deprivation combined with three-dimensional conformal radiotherapy at a minimum dose of 76 Gy (range 76-82 Gy; short-term androgen deprivation group) or the same treatment followed by 24 months of adjuvant androgen deprivation (long-term androgen deprivation group), stratified by prostate cancer risk group (intermediate risk vs high risk) and participating centre. Patients assigned to the short-term androgen deprivation group received 4 months of neoadjuvant and concomitant androgen deprivation with subcutaneous goserelin (2 months before and 2 months combined with high-dose radiotherapy). Anti-androgen therapy (flutamide 750 mg per day or bicalutamide 50 mg per day) was added during the first 2 months of treatment. Patients assigned to long-term suppression continued with the same luteinising hormone-releasing hormone analogue every 3 months for another 24 months. The primary endpoint was biochemical disease-free survival. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT02175212. FINDINGS Between Nov 7, 2005, and Dec 20, 2010, 178 patients were randomly assigned to receive short-term androgen deprivation and 177 to receive long-term androgen deprivation. After a median follow-up of 63 months (IQR 50-82), 5-year biochemical disease-free survival was significantly better among patients receiving long-term androgen deprivation than among those receiving short-term treatment (90% [95% CI 87-92] vs 81% [78-85]; hazard ratio [HR] 1·88 [95% CI 1·12-3·15]; p=0·01). 5-year overall survival (95% [95% CI 93-97] vs 86% [83-89]; HR 2·48 [95% CI 1·31-4·68]; p=0·009) and 5-year metastasis-free survival (94% [95% CI 92-96] vs 83% [80-86]; HR 2·31 [95% CI 1·23-3·85]; p=0·01) were also significantly better in the long-term androgen deprivation group than in the short-term androgen deprivation group. The effect of long-term androgen deprivation on biochemical disease-free survival, metastasis-free survival, and overall survival was more evident in patients with high-risk disease than in those with low-risk disease. Grade 3 late rectal toxicity was noted in three (2%) of 177 patients in the long-term androgen deprivation group and two (1%) of 178 in the short-term androgen deprivation group; grade 3-4 late urinary toxicity was noted in five (3%) patients in each group. No deaths related to treatment were reported. INTERPRETATION Compared with short-term androgen deprivation, 2 years of adjuvant androgen deprivation combined with high-dose radiotherapy improved biochemical control and overall survival in patients with prostate cancer, particularly those with high-risk disease, with no increase in late radiation toxicity. Longer follow-up is needed to determine whether men with intermediate-risk disease benefit from more than 4 months of androgen deprivation. FUNDING Spanish National Health Investigation Fund, AstraZeneca.

Anticipated Intraoperative Electron Beam Boost, External Beam Radiation Therapy, and Limb-Sparing Surgical Resection for Patients with Pediatric Soft-Tissue Sarcomas of the Extremity: A Multicentric Pooled Analysis of Long-Term Outcomes

PURPOSE To perform a joint analysis of data from 3 contributing centers within the intraoperative electron-beam radiation therapy (IOERT)-Spanish program, to determine the potential of IOERT as an anticipated boost before external beam radiation therapy in the multidisciplinary treatment of pediatric extremity soft-tissue sarcomas. METHODS AND MATERIALS From June 1993 to May 2013, 62 patients (aged <21 years) with a histologic diagnosis of primary extremity soft-tissue sarcoma with absence of distant metastases, undergoing limb-sparing grossly resected surgery, external beam radiation therapy (median dose 40 Gy) and IOERT (median dose 10 Gy) were considered eligible for this analysis. RESULTS After a median follow-up of 66 months (range, 4-235 months), 10-year local control, disease-free survival, and overall survival was 85%, 76%, and 81%, respectively. In multivariate analysis after adjustment for other covariates, tumor size >5 cm (P=.04) and R1 margin status (P=.04) remained significantly associated with local relapse. In regard to overall survival only margin status (P=.04) retained association on multivariate analysis. Ten patients (16%) reported severe chronic toxicity events (all grade 3). CONCLUSIONS An anticipated IOERT boost allowed for external beam radiation therapy dose reduction, with high local control and acceptably low toxicity rates. The combined radiosurgical approach needs to be tested in a prospective trial to confirm these results.

Extremity and Trunk Soft Tissue Sarcomas

Management of soft-tissue sarcomas of the extremities and trunk is optimally accomplished through a multidisciplinary team evaluation of each patient because of the diverse and complex nature of each clinical scenario. A team of orthopedic or surgical oncologists, radiation oncologists, medical oncologists, plastic surgeons, pathologists, and radiologists consider multiple issues including tumor stage, grade, location, and histologic type of tumor, as well as feasibility of a limb-sparing surgery, timing of radiation, and the patient’s performance status and comorbid illnesses. The rarity of these tumors in combination with the variety of presentation in extremity and truncal soft-tissue sarcomas limits the amount of prospective data available to reliably outline the management of all situations, and hence, there is a range of approaches utilized around the world today.

Síndrome de Pancoast e infiltración tumoral endobronquial como primera manifestación de un linfoma de Hodgkin

La causa mas frecuente del sindrome de Pancoast es un carcinoma broncogenico. Otras causas menos frecuentes son metastasis de tumores solidos, otros tumores intratoracicos, infecciones y neoplasias de estirpe hematologica. El sindrome de Pancoast por un linfoma es muy raro y los casos descritos corresponden fundamentalmente a linfomas no hodgkinianos. En una revision de la bibliografia encontramos un unico caso de linfoma de Hodgkin, pero que se manifesto durante la recidiva de la enfermedad. Nosotros aportamos un caso de linfoma de Hodgkin de tipo esclerosis nodular cuya primera manifestacion clinica fue este sindrome y cuyo diagnostico inicial se realizo mediante biopsia bronquial.

OC-0521: IORT after gross total resection combined with EBRT in extremity soft tissue sarcoma: a pooled analysis

treatment thereafter, their prognosis has been improving. We analyzed the results of our 18-year experience. Materials and Methods: Between 1993 and April 2011 48 patients (68 times) were treated. Their age ranged from 46 to 86 with a median of 64. There were 20 male patients and 28 females. Seventeen patients were unable to walk before IORT, while the remaining 31 were ambulant. IORT was given with proper energy electron beam from posteriorly shielding the spinal cord with lead of proper thickness. The doses of IORT ranged from 16Gy to 26Gy with a median of 20Gy. Ten patients received IORT more than once (2 to 6 times). External beam radiation therapy was administered in 29 patients, of which 1 received preoperatively (24Gy), 20 received postoperatively (20~40Gy, median 35.5Gy). All patients received thyroid stimulating hormone suppression therapy. Radioactive iodines (Iodine-131) were administered in 29 patients. Median follow-up period was 33 months. Results: Among 17 patients who had been unable to walk 15 became able to walk following IORT, while the remaining 2 died soon after the treatment (response: not evaluable). Overall median survival time of overall patients was 38 months. Threeand 5-year overall survival rates were 51% and 33%, respectively. Symptomatic recurrence was observed in 6 cases (14%). Conclusions: Well-differentiated thyroid cancer patients carried quite favorable prognoses considering their status prior to IORT. From our experience, aggressive treatment was justified since more than half of the patients survived 3 years and about one third of the patients survived 5 years. Furthermore, only small portion of the patients suffered from symptomatic recurrence. Our methods were very promising both for quantity and quality of life in the treatment of spinal metastases from well-differentiated thyroid cancer.

Pancoast Syndrome and Endobronchial Tumor Infiltration as the First Manifestation of Hodgkin Lymphoma

The most common cause of Pancoast syndrome is bronchogenic carcinoma. Other less common causes are solid tumor metastases, other chest tumors, infections, and hematologic neoplasms. Pancoast syndrome due to lymphoma is very rare, and cases described in the literature are essentially associated with non-Hodgkin lymphomas. In a review of the literature we found a single case of Pancoast syndrome secondary to a Hodgkin lymphoma; however, the syndrome manifested during recurrence of disease in that patient. We report a case of nodular sclerosis Hodgkin lymphoma which first manifested clinically as Pancoast syndrome and which was initially diagnosed by bronchial biopsy.

OC-0540: IOERT after gross total resection combined with EBRT in extremity sarcoma: a pooled analysis

ESTRO 35 2016 _____________________________________________________________________________________________________ Material and Methods: Using the National Cancer Data Base, we identified stage II seminoma patients treated with orchiectomy and either RT or MACT diagnosed from 19982012. Separately for stage IIA and IIB, factors affecting treatment modality (RT vs. MACT) were studied using a parsimonious multivariable logistic regression model. Propensity scores for treatment decision were incorporated into a multivariable Cox regression analysis of overall survival.