This is a retrospective review of 130 patients with node positive (N+) or common iliac node positive (M1a) prostate cancer treated with definitive radiotherapy. Patients were treated with long-term ADT and moderately or extremely hypofractionated RT to the prostate and pelvis, including the common iliac nodes. 75% of patients were staged with PSMA PET. At the time of biochemical failure, PSMA PET was acquired. At MFU 61 months, biochemical failure was similar (25.6% in the N+ group and 24.1% in the M1a group). Other outcomes were also similar between the 2 groups: distant metastasis (57% in N+ vs 73% in M1a, p=0.47), 5-year biochemical free survival (77.4% in N+ vs 70.4% in M1a, p=0.47), metastasis free survival (86.9% in N+ vs 79.4% in M1a, p=0.23), and overall survival (92.6% in N+ vs 90.1% in M1a, p=0.80). These findings suggest that common iliac node positive disease behaves similarly to other pelvic-node positive cases and should be treated (and perhaps staged) similarly.

Reference (Pub-Med Link): Chopade, P., Maitre, P., David, S., Panigrahi, G., Singh, P., Phurailatpam, R., & Murthy, V. (2022). Common Iliac Node-Positive Prostate Cancer Treated With Curative Radiation Therapy: N1 or M1a? International Journal of Radiation Oncology, Biology, Physics, 114(4), 711–717. https://doi.org/10.1016/j.ijrobp.2022.07.011

Key Institution: Tata Memorial Hospital, Mumbai, India
Keywords: Prostate

Managing localized prostate cancer in elderly men presents a challenge for clinicians. Current guidelines state that for patients with localized intermediate to high-risk prostate cancer, they should receive either prostatectomy or a combination of androgen deprivation therapy plus definitive radiotherapy, which may be external beam radiotherapy with or without brachytherapy boost. The purpose of this study was to analyze the oncological outcomes in elderly men after they received high-dose rate brachytherapy (HDB) boost.

They conducted an observational, retrospective, single-institution study in the country of France. 518 patients from the years 2008 to 2022 received a HDB boost and 380 were analyzed and split into two groups (≤70y:177pts [46.6%] vs. > 70y:203pts [53.4%]). With MFU of 72.6 months [67–83] for the whole cohort, 5-y bRFS, 5-y CSS and 5-y OS were 88% [85–92], 99% [97–100] and 94% [92–97] respectively; there was no statistical difference between the two age groups except for 5-y CSS (p = 0.05). There was no statistical difference between the two age-groups (Age <70 vs Age >70) in regards to late GI toxicity. The authors concluded that for intermediate and high-risk prostate cancer in the elderly, brachytherapy boost remains important to achieve optimal oncological outcomes. They felt that the toxicity profile of a brachytherapy boost appeared acceptable. Oftentimes, the elderly patients can be undertreated because their age is taken into account. They found that intermediate/high risk elderly prostate cancer patients benefits less from receiving standards of care. Brachytherapy boost remains efficient and feasible in the elderly.

(Open Access)

Reference (Pub-Med Link): Marotte, D., Gal, J., Schiappa, R., Gautier, M., Boulahssass, R., Chand-Fouche, M.-E., & Hannoun-Levi, J.-M. (2022). High-dose-rate brachytherapy boost for elderly patients with intermediate to high-risk prostate cancer: 5-year clinical outcome of the PROSTAGE cohort. Clinical and Translational Radiation Oncology, 35, 104–109. https://doi.org/10.1016/j.ctro.2022.05.001

Key Institution: Antoine Lacassagne Cancer Center
Keywords: Prostate cancer, Brachytherapy

This is a prospective randomized Phase II study of 126 patients with borderline resectable pancreatic adenocarcinoma treated with neoadjuvant FOLFIRINOX with or without neoadjuvant SBRT / hypofractionated RT prior to surgery. Patients were treated with 8 cycles of mFOLFIRINOX or 7 cycles of mFOLFIRINOX followed by SBRT (33-40 Gy in 5 Fx) or hypofractionated RT (25 Gy in 5 Fx). Patients without disease progression underwent pancreatectomy followed by 4 cycles of postoperative FOLFOX6. The primary endpoint was 18-month OS compared with historical control rate of 50%. The SBRT arm was closed early due to low rates of R0 resection (33% vs 57% in the FOLFIRINOX arm). The 18-month OS was 66.7% vs 47.3% in favor of the neoadjuvant FOLFIRINOX alone arm, although lack of full accrual in the SBRT arm resulted in an inability to conclude statistical efficacy. This study demonstrates that in this patient population, there is no apparent benefit to the addition of SBRT to FOLFIRINOX for borderline resectable patients. The authors do not speculate on the possible reasons for lower rates of R0 resection in the SBRT arm. It is unclear from the manuscript what level of experience the participating centers have in performing pancreatectomies in a radiated field.

Reference (Pub-Med Link): Katz, M. H. G., Shi, Q., Meyers, J. et al. (2022). Efficacy of Preoperative mFOLFIRINOX vs mFOLFIRINOX Plus Hypofractionated Radiotherapy for Borderline Resectable Adenocarcinoma of the Pancreas: The A021501 Phase 2 Randomized Clinical Trial. JAMA Oncology, 8(9), 1263–1270. https://doi.org/10.1001/jamaoncol.2022.2319

Key Institution: Multi-institutional, USA
Keywords: Pancreatic Cancer, SBRT

In this prospective pilot in silico trial investigators at Washington University treated 8 patients with abdominal oligometastases using SBRT to a dose of 50 Gy in 5 fractions. Patients were re-planned based on daily CT scans collected on the Ethos platform using the Varian Ethos emulator. Stomach and bowel dose was exceeded in 30/40 fractions delivered using the original plans Only 2/40 OAR violations were present in the adapted plans. Target coverage were also improved by adaptation. Adaptation required a median of 23 minutes (range 11-47 minutes).

Reference (Pub-Med Link): Schiff, J. P., Stowe, H. B., Price, A. et al. (2022). In Silico Trial of Computed Tomography-Guided Stereotactic Adaptive Radiation Therapy (CT-STAR) for the Treatment of Abdominal Oligometastases. International Journal of Radiation Oncology, Biology, Physics. https://doi.org/10.1016/j.ijrobp.2022.06.078