Prostate Cancer (PCa) is the second leading cause of cancer death in the elderly (≥75 years). There is currently little data on hypofractionated radiotherapy in older patients affected by localized PCa. We present the long-term results of hypofractionated radiotherapy in elderly patients with localized PCa from the IPOPROMISE database. retrospective analysis of 719 PCa elderly (≥75 years) patients treated with daily volumetric image-guided hypofractionated radiotherapy between 2007 and 2020. For survival endpoints, we used Kaplan-Meier survival curves and univariate and multivariable Cox’s proportional hazards regression models. Median age at PCa diagnosis was 78.4 years (interquartile [IQR], 76.8–80.3 years), 74

Background Moderate hypofractionated radiotherapy is a treatment option for the cure of localized prostate cancer (PCa) patients based on the results of randomized prospective trials, but there is a clinical concern about the relatively short length of follow-up, and real-world results on outcome and toxicity based on cutting-edge techniques are lacking. The objective of this study is to present the long-term results of a large multicentric series. Materials and methods We retrospectively evaluated 1325 PCa patients treated with daily volumetric image-guided hypofractionated radiotherapy between 2007 and 2020 in 16 Centers. For survival endpoints, we used Kaplan–Meier survival curves and fitted univariate and multivariable Cox’s proportional hazards regression models to study the association between the clinical variables and each survival type. Results At the end of the follow-up, 11 patients died from PCa. The 15-year values of cancer-specific survival (CSS) and biochemical relapse-free survival (b-RFS) were 98.5% (95%CI 97.3–99.6%) and 85.5% (95%CI 81.9–89.4%), respectively. The multivariate analysis showed that baseline PSA, Gleason score, and the use of androgen deprivation therapy were significant variables for all the outcomes. Acute gastrointestinal (GI) and genitourinary (GU) toxicities of grade ≥ 2 were 7.0% and 16.98%, respectively. The 15-year late grade ≥ 2 GI and GU toxicities were 5% (95%CI 4–6%) and 6% (95%CI 4–8%), respectively. Conclusion Real-world long-term results of this multicentric study on cutting-edge techniques for the cure of localized PCa demonstrated an excellent biochemical-free survival rate of 85.5% at 15 years, and very low rates of ≥ G3 late GU and GI toxicity (1.6% and 0.9% respectively), strengthening the results of the available published trials.

Background and Purpose: Data on immunoresponse after SARS-CoV-2 vaccines for patients treated with exclusive radiotherapy (RT) are scarce. Since RT may affect the immune system, we conducted the MORA trial (Antibody response and cell-mediated immunity of MOderna mRNA-1273 vaccine in patients treated with RAdiotherapy). Materials and Methods: Data regarding humoral and cellular immune response of patients treated with RT were prospectively collected after the second and third dose of mRNA vaccines. Results: Ninety-two patients were enrolled. With a median of 147 days after the second dose, the median SARS-CoV-2 IgG titer was 300 BAU/mL: six patients were seronegative (Spike IgG titer & LE; 40 BAU/mL), whereas 24, 46 and 16 were poor responders (Spike IgG titer:41-200 BAU/mL), responders (Spike IgG titer:201-800 BAU/mL) and ultraresponders (Spike IgG titer > 800 BAU/mL), respectively. Among seronegative patients, two patients were negative also for cell mediated response, as tested with IFN-& gamma; release Assay (IGRA) test. With a median of 85 days after the third dose, the median SARS-CoV-2 IgG titer was 1632 BAU/mL in 81 patients: only two pa-tients were seronegative, whereas 16 and 63 patients were responders and ultraresponders, respectively. Among the 2 persistently seronegative patients, IGRA test was negative in one who had previously received anti-CD20 therapy. Documented paucisymptomatic (n = 3) or asymptomatic (n = 4) infection occurred after the third dose, during the Omicron wave. Conclusion: In patients treated with exclusive RT, even during the Omicron breakthrough, robust humoral response and clinical protection from severe SARS-CoV-2 disease were achievable with three doses of mRNA vaccine.

OBJECTIVE Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. METHODS Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. RESULTS Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. CONCLUSION This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. ADVANCES IN KNOWLEDGE Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome.

Purpose: We report a subgroup analysis primarily focused on human papillomavirus (HPV)-related oropharyngeal cancer (OPC) from the Cetuximab Plus Radiotherapy Versus Cisplatin Plus Radiotherapy in Locally Advanced Head and Neck Cancer (CTXMAB+RT; ClinicalTrials.gov identifier NCT01216020) trial comparing radiation therapy with concomitant cisplatin (CDDP) versus concomitant cetuximab (CTX) as first-line treatment of locally advanced head and neck cancer.Methods and Materials: The data from all the patients in the CTXMAB+RT trial were reviewed and separately analyzed in 3 groups: p16-positive OPC, p16-negative OPC, and all other cancer sites. The endpoints of interest were locoregional control (LC), metastasis-free survival, cancer-specific survival (CSS), and overall survival (OS). Severe and fatal infectious complications were also reanalyzed to more thoroughly investigate the association between CTX treatment and potentially life-threatening reactions.Results: A total of 33 patients had OPC. The HPV status was available for 30 of the 33 patients. Thus, 3 patients treated with CDDP but with unknown HPV status were excluded from the survival analysis. The small number of patients in each group did not allow for significance to be reached for any of the outcomes analyzed. A trend favored the CDDP arm in the p16-positive group for the 2-year LC and OS/CSS rates (100% vs 72.9% and 100% vs 77.8% for CDDP vs CTX). In this group of patients, the hazard ratio for the treatment arm (CTX vs CDDP) was 4.7 (95% confidence interval [CI] 0.5-40.3) for LC, 3.4 (95% CI 0.4-30.5) for OS, and 2.4 for CSS (95% CI 0.2-23.2). A survival benefit favoring the CDDP arm was not evident in the p16-negative OPC group or for patients with cancer located in other sites. Serious or fatal infectious complications occurred only in the CTX arm.Conclusions: In patients with p16-positive OPC in the CTXMAB+RT trial, CTX had lower efficacy than CDDP, with possible implications for treatment selection in this clinical setting. (C) 2016 Elsevier Inc. All rights reserved.

Aims and Background In 2002, a survey including 1759 patients treated from 1980 to 1998 established a “benchmark” Italian data source for prostate cancer radiotherapy. This report updates the previous one. Methods Data on clinical management and outcomes of 3001 patients treated in 15 centers from 1999 through 2003 were analyzed and compared with those of the previous survey. Results Significant differences in clinical management (-10% had abdominal magnetic resonance imaging; +26% received ≥70 Gy, +48% conformal radiotherapy, −20% pelvic radiotherapy) and in G3–4 toxicity rates (-3.8%) were recorded. Actuarial 5-year overall, disease-specific, clinical relapse-free, and biochemical relapse-free survival rates were 88%, 96%, 96% and 88%, respectively. At multivariate analysis, D'Amico risk categories significantly impacted on all the outcomes; higher radiotherapy doses were significantly related with better overall survival rates, and a similar trend was evident for disease-specific and biochemical relapse-free survival; cumulative probability of 5-year late G1–4 toxicity was 24.8% and was significantly related to higher radiotherapy doses (P <0.001). Conclusions The changing patterns of practice described seem related to an improvement in efficacy and safety of radiotherapy for prostate cancer. However, the impact of the new radiotherapy techniques should be prospectively evaluated.

You have accessJournal of UrologyProstate Cancer: Localized IV1 Apr 2014MP46-12 FOURTEEN YEARS OF EXPERIENCE IN LOW DOSE RATE BRACHYTHERAPY FOR EARLY-STAGE PROSTATE CANCER IN ITALY: CHARACTERISTICS AND BIOCHEMICAL OUTCOMES IN A COHORT OF 2279 PATIENTS FROM NINE ITALIAN CENTRES Francesco Mistretta, Andrea Losa, Luciano Dante Nava, Paola Mangili, Giovanni Fellin, Francesco Pio Mangiacotti, Giovanni Ghiso, Vincesco Fusco, Marcello Mignogna, Beniamino La Face, Marco Stefanacci, Giovanni Silvano, and Maria Alessandra Mirri Francesco MistrettaFrancesco Mistretta , Andrea LosaAndrea Losa , Luciano Dante NavaLuciano Dante Nava , Paola MangiliPaola Mangili , Giovanni FellinGiovanni Fellin , Francesco Pio MangiacottiFrancesco Pio Mangiacotti , Giovanni GhisoGiovanni Ghiso , Vincesco FuscoVincesco Fusco , Marcello MignognaMarcello Mignogna , Beniamino La FaceBeniamino La Face , Marco StefanacciMarco Stefanacci , Giovanni SilvanoGiovanni Silvano , and Maria Alessandra MirriMaria Alessandra Mirri View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1445AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives To report the characteristics and biochemical outcomes of a cohort of 2279 localized prostate cancer (PCA) patients treated with low-dose rate brachytherapy ( LDR-BT) in 9 Italian centres (Trento, Milan S. Raffaele, Savona, Brescia, Lucca, Pistoia, Rionero in Vulture, Rome, Taranto). Methods From 1998 to 2012, 2279 patients with localized PCA were treated with iodine-125 (125I) or palladium-103 (103Pd) implants. Global data were collected and retrospectively analyzed. Patients were stratified into low (LR), intermediate (IR) and high (HR) risk groups through the D’Amico’s risk group classification. Freedom from biochemical failure (FFbF) and overall (OS) and disease specific (DSS) survival were calculated according to the Kaplan-Meier method. Biochemical failure was defined according to the Phoenix (PSA nadir plus 2 ng/mL) definition. Results Overall median follow-up was 44 months (3-143). Patients lost to follow up were 243/2279 (10,7%). Median age was 67 years (45-83), median pre-treatment PSA value was 6,66 ng/ml (0,64 -80) and the average pre-implant prostate volume was 35,7 cm3 (4-86,6). According to D’Amico’s risk group classification, 1603 (70,3%) patients has been defined as LR, 493 (21,6%) as IR, 59 ( 2,6%) as HR while 124 (5,4%) were not assessable because of the lack of completeness of data. Neo-adjuvant hormone therapy (OT) was prescribed to the 35,1 % (562/1603) of LR patients, to the 46,6% (230/493) of IR patients and to the 47,5% (28/59) of HR patients. 2197 (96,4%) patients received LDR-BT as a single curative modality and 82 (3,6%) as a boost with external beam RT. I125 and Pd 103 seeds were implanted in 2214 (97,1%) and 65 (2,8%) patients, respectively. The median D90 in patients implanted as monotherapy, was 150,8 Gy for I125 and 126,5 Gy for Pd103. The average V100 was 92% and median 94% for the group of I125 implants, and 88,7% and 90,3 for Pd 103 implants. The 5ys and10ys actuarial OS was 94% and 85%, and the same figures were 99% and 96% for DSS. The 3ys, 5ys,7ys and 10ys FFbF was overall 95%, 93%, 90% and 84%. The 5ys FFbF was 96%, 87% and 75% for LR, IR and HR group respectively. The 5ys FFbF was 95% and 90% if was achieved a D90 > or < 90% of prescribed dose. Conclusions This multi-institutional early report provides information on a large proportion of Italian patients. Our results indicate that a good biochemical outcome is achieved with permanent implant and that an implant of good quality, both for case selection and post implant dosimetric parameters, has been obtained. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e514 Advertisement Copyright & Permissions© 2014Metrics Author Information Francesco Mistretta More articles by this author Andrea Losa More articles by this author Luciano Dante Nava More articles by this author Paola Mangili More articles by this author Giovanni Fellin More articles by this author Francesco Pio Mangiacotti More articles by this author Giovanni Ghiso More articles by this author Vincesco Fusco More articles by this author Marcello Mignogna More articles by this author Beniamino La Face More articles by this author Marco Stefanacci More articles by this author Giovanni Silvano More articles by this author Maria Alessandra Mirri More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...