Prostate-specific antigen bounce predicts for a favorable prognosis following brachytherapy: a meta-analysis.

PURPOSE: Controversy exists whether the prostate-specific antigen (PSA) bounce phenomenon following definitive radiation for prostate cancer has prognostic significance. Here, we perform a meta-analysis to determine the association between PSA bounce and biochemical control after brachytherapy alone. MATERIAL AND METHODS: We reviewed Medline, EMBASE, and CENTRAL citations through February 2012. Studies that recorded biochemical failure rates in bouncers and non-bouncers were included. Hazard ratios describing the impact of bounce on biochemical failure were extracted directly from the studies or calculated from survival curves. Pooled estimates were obtained using the inverse variance method. A random effects model was used in cases of significant effect heterogeneity (p \u3c 0.10 using Q test). RESULTS: The final analysis included 3011 patients over 6 studies treated with brachytherapy. Meta-analysis revealed that patients experiencing PSA bounce after brachytherapy, conferred a decreased risk of biochemical failure (random effects model HR = 0.42, 95% CI: 0.30-0.59; p \u3c 0.001). CONCLUSIONS: Our meta-analysis determined that PSA bounce predicts for improved biochemical control following brachytherapy. To our knowledge, this is the first study describing this effect

The role of pre- and post-SRS systemic therapy in patients with NSCLC brain metastases

Purpose: We report our experience with stereotactic radiosurgery (SRS) for NSCLC brain metastases. We then assess the prognostic value of pre- and post-SRS systemic therapy (PrSST and PoSST) and evaluate the timing of PoSST.Methods: In this retrospective study, we analyzed 96 patients with lung cancer and ECOG PS ≤ 3 who underwent SRS during 2007-2013. Recorded factors included SRS treatment parameters, systemic status of disease (SDS) at time of SRS, and the use of PrSST and PoSST. SDS was designated as pulmonary disease or extrapulmonary disease. For analysis, the SRS-PoSST interval (SPI) was divided into ≤30 days and >30 days. Univariate and multivariate analyses were performed.Results: 85 patients with NSCLC were included in this analysis. 48% received PrSST and 48% received PoSST. 57% of patients had pulmonary disease while 40% had extrapulmonary disease. 46% of patients had synchronous metastases. At a median follow-up of 6 months, the median survival was 6.4 months and the actuarial overall survival at 3, 6, 12, and 36 months was 80%, 52%, 31%, and 6%. Extrapulmonary disease (p = 0.008) negatively predicted for survival while the receipt of any systemic therapy (p = 0.050) or PoSST alone (p = 0.039) positively predicted for survival. In patients receiving PoSST, an SPI >30 days positively predicted for survival (HR 0.28, 95% CI 0.13-0.62, p = 0.002) regardless of SDS.Conclusion: Our results indicate the prognostic importance of systemic therapy and specifically PoSST. Additionally, delaying the initiation of PoSST to >30 days seems beneficial. This finding was potentially influenced by neurotoxicity after SRS. Further investigation is warranted to define the optimal SPI

The role of pre- and post-SRS systemic therapy in patients with NSCLC brain metastases

Purpose: We report our experience with stereotactic radiosurgery (SRS) for NSCLC brain metastases. We then assess the prognostic value of pre- and post-SRS systemic therapy (PrSST and PoSST) and evaluate the timing of PoSST.Methods: In this retrospective study, we analyzed 96 patients with lung cancer and ECOG PS ≤ 3 who underwent SRS during 2007-2013. Recorded factors included SRS treatment parameters, systemic status of disease (SDS) at time of SRS, and the use of PrSST and PoSST. SDS was designated as pulmonary disease or extrapulmonary disease. For analysis, the SRS-PoSST interval (SPI) was divided into ≤30 days and &gt;30 days. Univariate and multivariate analyses were performed.Results: 85 patients with NSCLC were included in this analysis. 48% received PrSST and 48% received PoSST. 57% of patients had pulmonary disease while 40% had extrapulmonary disease. 46% of patients had synchronous metastases. At a median follow-up of 6 months, the median survival was 6.4 months and the actuarial overall survival at 3, 6, 12, and 36 months was 80%, 52%, 31%, and 6%. Extrapulmonary disease (p = 0.008) negatively predicted for survival while the receipt of any systemic therapy (p = 0.050) or PoSST alone (p = 0.039) positively predicted for survival. In patients receiving PoSST, an SPI &gt;30 days positively predicted for survival (HR 0.28, 95% CI 0.13-0.62, p = 0.002) regardless of SDS.Conclusion: Our results indicate the prognostic importance of systemic therapy and specifically PoSST. Additionally, delaying the initiation of PoSST to &gt;30 days seems beneficial. This finding was potentially influenced by neurotoxicity after SRS. Further investigation is warranted to define the optimal SPI.</p

Biological impact of geometric uncertainties: what margin is needed for intra-hepatic tumors?

<p>Abstract</p> <p>Background</p> <p>To evaluate and compare the biological impact on different proposed margin recipes for the same geometric uncertainties for intra-hepatic tumors with different tumor cell types or clinical stages.</p> <p>Method</p> <p>Three different margin recipes based on tumor motion were applied to sixteen IMRT plans with a total of twenty two intra-hepatic tumors. One recipe used the full amplitude of motion measured from patients to generate margins. A second used 70% of the full amplitude of motion, while the third had no margin for motion. The biological effects of geometric uncertainty in these three situations were evaluated with Equivalent Uniform Doses (EUD) for various survival fractions at 2 Gy (SF₂).</p> <p>Results</p> <p>There was no significant difference in the biological impact between the full motion margin and the 70% motion margin. Also, there was no significant difference between different tumor cell types. When the margin for motion was eliminated, the difference of the biological impact was significant among different cell types due to geometric uncertainties. Elimination of the motion margin requires dose escalation to compensate for the biological dose reduction due to the geometric misses during treatment.</p> <p>Conclusions</p> <p>Both patient-based margins of full motion and of 70% motion are sufficient to prevent serious dosimetric error. Clinical implementation of margin reduction should consider the tumor sensitivity to radiation.</p

Radiation Recall Dermatitis in Patients Treated with Sorafenib

Introduction. Radiation recall dermatitis (RRD) is a phenomenon that occurs in previously irradiated areas shortly after administration of a chemotherapeutic agent. As the use of sorafenib expands, the incidence of radiation recall dermatitis induced by sorafenib will likely increase. Here, we report on a patient who developed RRD and describe his clinical characteristics along with a review of the literature. Case Presentation. Our patient was treated with palliative radiation therapy (RT) to a painful metastatic hepatocellular carcinoma lesion in the right forearm. He completed his radiation course with grade 1 dermatitis, which had resolved by the time he was started on sorafenib 400 mg twice daily 7 days afterwards. On the 21st day after RT, he presented with desquamation and erythema in the previously irradiated area of the right forearm, consistent with RRD. The sorafenib was discontinued and his symptoms subsequently resolved with conservative topical management. Conclusions. Although the pathophysiologic mechanism of sorafenib-related radiation recall dermatitis remains to be investigated, practitioners should be aware of its presence and management in order to improve clinical outcomes