Shaping Clinical Policy for Salvage Radiotherapy After Radical Prostatectomy in Prostate Cancer: Bridging the Gap Between Clinical Trials and Daily Practice

IF 2.9 2区 医学 Q2 ONCOLOGY Cancer Medicine Pub Date : 2024-11-01 DOI:10.1002/cam4.70362
Piero Bettoli, Evangelina Röling, Moises Russo, María Fernanda Sánchez, Inti Paredes, Jorge Sapunar
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Abstract

Purpose and Objective

Salvage radiotherapy (sRT) can have similar outcomes to adjuvant radiotherapy (aRT) if administered at the earliest evidence of biochemical recurrence. RADICALS-RT was the first trial to support this hypothesis and a policy of observation after radical prostatectomy (RP) with early sRT has become the new standard of care since then. This study assessed the impact of RADICALS-RT in the clinical practice regarding the timing of sRT for prostate cancer initially treated with RP.

Methods

Data from 297 patients who underwent sRT after radical RP were retrospectively collected. Two groups were created and analyzed on the basis of the date of RADICALS-RT presentation at ESMO. After these results were released in October 2021, our institutional postoperative radiotherapy policy was revisited, and a third group was created and analyzed separately.

Results

Median PSA for Groups 1, 2, and 3 were 0.33, 0.27, and 0.2, respectively. Less than one-third of patients in Groups 1 and 2 had a postoperative PSA of 0.2 ng/mL or less at the time of sRT. Group 3 showed statistically significant differences in median PSA at the time of sRT compared with Groups 1 and 2.

Conclusions

RADICALS-RT demonstrated a significant impact on clinical practice only after being complemented with real local evidence.

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制定前列腺癌根治性前列腺切除术后挽救性放疗的临床政策:缩小临床试验与日常实践之间的差距。
目的和目标:如果在最早出现生化复发迹象时进行抢救性放疗(sRT),其疗效可与辅助放疗(aRT)相媲美。RADICALS-RT是首个支持这一假设的试验,自此以后,在根治性前列腺切除术(RP)后进行观察并尽早进行挽救性放疗的政策成为了新的治疗标准。本研究评估了 RADICALS-RT 在临床实践中对最初接受 RP 治疗的前列腺癌患者进行 sRT 时机选择的影响:方法:回顾性收集了 297 例接受根治性前列腺癌术后 sRT 患者的数据。根据 RADICALS-RT 在 ESMO 上发表的日期分为两组进行分析。这些结果于2021年10月公布后,我们重新审视了本机构的术后放疗政策,并设立了第三组,单独进行分析:第一、第二和第三组的 PSA 中位数分别为 0.33、0.27 和 0.2。不足三分之一的第 1 组和第 2 组患者在接受 sRT 时的术后 PSA 为 0.2 纳克/毫升或更低。与第 1 组和第 2 组相比,第 3 组患者接受 sRT 时的 PSA 中位数在统计学上有显著差异:结论:RADICALS-RT只有在得到当地实际证据的补充后,才能对临床实践产生重大影响。
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来源期刊
Cancer Medicine
Cancer Medicine ONCOLOGY-
CiteScore
5.50
自引率
2.50%
发文量
907
审稿时长
19 weeks
期刊介绍: Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.
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