Quality of life after high-dose-rate brachytherapy monotherapy for prostate cancer

Purpose There is little information in the literature on health-related quality of life (HRQOL) changes due to high-dose-rate (HDR) brachytherapy monotherapy for prostate cancer. Materials and Methods We conducted a prospective study of HRQOL changes due to HDR brachytherapy monotherapy for low risk or favorable intermediate risk prostate cancer. Sixty-four of 84 (76%) patients who were treated between February 2011 and April 2013 completed 50 questions comprising the Expanded Prostate Cancer Index Composite (EPIC) before treatment and 6 and/or 12 months after treatment. Results Six months after treatment, there was a significant decrease (p<0.05) in EPIC urinary, bowel, and sexual scores, including urinary overall, urinary function, urinary bother, urinary irritative, bowel overall, bowel bother, sexual overall, and sexual bother scores. By one year after treatment, EPIC urinary, bowel, and sexual scores had increased and only the bowel overall and bowel bother scores remained significantly below baseline values. Conclusions HDR brachytherapy monotherapy is well-tolerated in patients with low and favorable intermediate risk prostate cancer. EPIC urinary and sexual domain scores returned to close to baseline 12 months after HDR brachytherapy

Terminologie à utiliser pour l’étude et la prise en charge des échinococcoses : adaptation du consensus international à la langue française

International audienceEchinococcoses are zoonoses affecting accidentally humans and their management requires the involvement of specialists from numerous disciplines. A standardization of the international terminology was published recently by the World Association of Echinococcosis. A multidisciplinary working group was established to propose an adaptation to the French language, taking the main French-speaking areas endemic for echinococcoses into account. The main recommendations are: 1) the use of single names for each disease associated with the different Echinococcus species « échinococcose kystique », « échinococcose alvéolaire » and « échinococcose néotropicale »; 2) the restriction of the use of « hydatique » to the larval stage of the cluster of Echinococcus granulosus sensu lato species; 3) the harmonization of terms used to describe the structure of the cysts; 4) the adaptation of the term used to name the ex-« vésicules filles », that now should be replaced by « kystes filles », to better comply with the international terminology. Concerning the surgical treatment of cystic echinococcosis, the description system and the acronym « AORC » (the same in English and in French for Approach/Abord, Opening/Ouverture, Resection/Résection, and Completeness/Complétude) were adopted. The use of this new terminology is crucial for the coherence between scientific publications and textbooks, and especially for a better understanding of the transmission of these diseases as well as for patients’ management.Les échinococcoses sont des zoonoses touchant les humains de manière accidentelle et leur prise en charge implique l’intervention de spécialistes issus de nombreuses disciplines. Un consensus a récemment été obtenu par l’Association mondiale de l’échinococcose sur la standardisation de la terminologie internationale, en anglais. Un groupe de travail francophone multidisciplinaire a été constitué pour proposer une adaptation spécifique à la langue française, en prenant en compte les principales régions du monde francophone endémiques pour les échinococcoses. Les principaux changements adoptés sont : 1) la dénomination des différentes maladies associées au développement du métacestode des différentes espèces d’échinocoques, « échinococcose kystique », « échinococcose alvéolaire » et « échinococcose néotropicale » ; 2) la restriction de l’usage de l’adjectif « hydatique » au stade larvaire du cluster d’espèces Echinococcus granulosus sensu lato ; 3) l’harmonisation des expressions qui décrivent la structure des kystes ; 4) la mise en cohérence avec la terminologie internationale de la dénomination des ex-« vésicules filles », qui sont désormais appelées « kystes filles ». Concernant le traitement chirurgical de l’échinococcose kystique, le système de description et l’acronyme « AORC », identique en français et en anglais pour Abord/Approach, Ouverture/Opening, Résection/Resection, Complétude/Completeness, ont été retenus. L’adoption de cette nouvelle terminologie est essentielle pour la cohérence des publications et des ouvrages pédagogiques, et surtout pour une meilleure compréhension de la transmission de ces maladies et une meilleure prise en charge des patients

Consensus Recommendations for Radiation Therapy Contouring and Treatment of Vulvar Carcinoma

PURPOSE: The purpose of this study was to develop a radiation therapy (RT) contouring atlas and recommendations for women with postoperative and locally advanced vulvar carcinoma. METHODS AND MATERIALS: An international committee of 35 expert gynecologic radiation oncologists completed a survey of the treatment of vulvar carcinoma. An initial set of recommendations for contouring was discussed and generated by consensus. Two cases, 1 locally advanced and 1 postoperative, were contoured by 14 physicians. Contours were compared and analyzed using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE), and a 95% confidence interval contour was developed. The level of agreement among contours was assessed using a kappa statistic. STAPLE contours underwent full committee editing to generate the final atlas consensus contours. RESULTS: Analysis of the 14 contours showed substantial agreement, with kappa statistics of 0.69 and 0.64 for cases 1 and 2, respectively. There was high specificity for both cases (≥99%) and only moderate sensitivity of 71.3% and 64.9% for cases 1 and 2, respectively. Expert review and discussion generated consensus recommendations for contouring target volumes and treatment for postoperative and locally advanced vulvar cancer. CONCLUSIONS: These consensus recommendations for contouring and treatment of vulvar cancer identified areas of complexity and controversy. Given the lack of clinical research evidence in vulvar cancer radiation therapy, the committee advocates a conservative and consistent approach using standardized recommendations

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

BACKGROUND: Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. METHODS: RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided a of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. FINDINGS: Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60-69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0-10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612-0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6-75·7) in the short-course ADT group and 78·1% (74·2-81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. INTERPRETATION: Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. FUNDING: Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society.Published version, accepted versionRDUH staff can access the full-text of this article by clicking on the 'Additional Link' above and logging in with NHS OpenAthens if prompted