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Prostate cancer cells typically require androgen hormones such as testosterone to grow, and so ADT is usually recommended for patients suffering with prostate cancer.
The study presented at ASTRO enrolled 362 patients at 9 cancer centers in Spain, in order to assess if HDRT combined with long-term androgen deprivation (LTAD) therapy for 28 months was associated with better patient outcomes when compared to HDRT combined with short-term ADT (STAD) for four months. Patients were then randomly assigned to two groups either receiving adjuvant Goserelin (a luteinizing hormone that suppresses production of testosterone) subcutaneously for 24 additional months (LTAD) or receiving only four months of ADT (STAD).
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Purpose: To identify predictors for prolonged survival free from salvage whole brain radiation therapy (WBRT) in patients with brain metastases treated with stereotactic radiosurgery (SRS) as their initial radiotherapy approach. Materials and methods: Patients with brain metastases treated with SRS from 2001 to 2013 at our institution were identified. Conclusion: A subset of patients with brain metastases can achieve long-term survival after upfront SRS without the need for salvage WBRT. The appropriate upfront radiotherapy approach for newly diagnosed brain metastases is currently controversial with options that include whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), or both (5–9). In compliance with institutional review board approval, the records of patients with brain metastases treated with SRS at our institution between 2001 and 2013 were reviewed. Patients were seen in follow-up approximately 1 month after their SRS procedure and every 3 months following their initial post-procedure visit.
Actuarial local and distant CNS failures and overall survival were calculated using the Kaplan–Meier method. Three hundred and eight patients were treated with SRS alone and fit inclusion criteria for analysis. The variables significantly associated with favorable WBRT-free survival identified by the univariate analyses were further evaluated with a multivariate binary logistic regression analysis (Table 2). Stereotactic radiosurgery alone has been adopted by many to treat patients with limited brain metastases and expected survival ≥3 months.
Several nomograms have been developed to predict survival in patients with brain metastases. Our study aimed to identify patient, disease, and treatment variables that might predict for patients who are likely to not only have prolonged survival, but also are unlikely to require salvage WBRT. In this study, predictors of ≥1 year WBRT-free survival on univariate analyses included younger age, RPA class I, breast primary, new or controlled primary, asymptomatic presentation, surgical resection of a brain metastasis, fewer brain metastases, absence of extracranial metastases, and oligometastatic disease.
The concept of oligometastatic disease was initially described by Hellman and Weichselbaum in 1995 (17). Another interesting, but not surprising, finding from our analysis is the relationship between primary tumor type and WBRT-free survival. The interpretation of our results is limited by the retrospective nature and non-randomized study design, which introduces multiple well-described biases in data collection and analysis (30). Our results identify several variables related to intracranial and systemic disease burden that can help select patients that are likely to achieve prolonged survival and less likely to require salvage WBRT. Carbon Ion Therapy has been shown in Japan to increase survival rates in solid mass tumours, such as pancreatic cancers.
No longer paying attention to the rules that your body dictates, cancer becomes a rebel without a cause for the host.
That brings us to why Carbon Ion Therapy (radiation) is bringing various cancers under control with less adverse effects. A carbon ion is a rather large particle that selectively kills the genetic (DNA) of the bad cell and doesn’t really disturb the DNA of the good cells. This type of radiation treatment has been used in both Japan and Germany with great success. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Radiation therapy (RT) together with ADT is a standard of care for patients with locally advanced prostate cancer.
Both groups received four months of neoadjuvant ADT + HDRT, with a median RT dose to the prostate of 78 Gy.
The clinician must choose the type of local treatment as well as the optimal timing and sequence of hormone therapy. This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. Predictors identified in this study can help select patients that might benefit most from a treatment strategy of SRS alone.
With recent improvements in life-prolonging systemic therapies, the incidence of brain metastases is increasing (2).


Given the potential late neurocognitive effects associated with WBRT, it would be particularly attractive to avoid it in patients with longer life expectancies (10–13). Several tools have been developed to estimate survival; however, there are no available methods that predict which patients are likely to achieve long-term survival without the need for salvage WBRT (3, 4, 14, 15). Occasionally, patients were found to have additional occult metastases at the time of SRS and >4 lesions were treated with SRS alone. Age distribution, number of brain metastases, and size of brain metastases were evaluated by two-tailed t-tests with Welch’s correction. When controlling for covariates, independent predictors of favorable WBRT-free survival were asymptomatic presentation, breast primary, single brain metastasis, absence of extracranial metastases, and oligometastatic disease burden. We intentionally selected two groups of patients with the contrasting outcomes after SRS alone.
On multivariate analysis, asymptomatic presentation, breast primary, single brain metastasis, absence of extracranial metastases, and oligometastatic disease burden remained significantly associated with prolonged WBRT-free survival.
It is defined as a state between local-regional disease and wide-spread metastatic disease where metastases are few in number. Multiple prior reports have demonstrated that compared to other histologies, overall survival outcomes are relatively better in patients with breast cancer (4, 27). Instead of the 10% survival rate, over 3-5 years that would shoot up to 50% to utilize this new type of radiation. Cancer’s ultimate goal is to take over the entire organism forcing complete domination until the host passes away.
The device can target just the area of the cancer without negatively affecting any of the surrounding good cells. Older radiation methods had smaller particles that did as much destruction to the cancer as the normal cells. Fortunately, the cost of treatment is reported to be similar to that of today’s radiation facilities. Moreover, rapid and ongoing advances in treatment options require that physicians consider options that can impact both survival and quality-of-life. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Although the estimated median survival for all patients with brain metastases is only 4–6 months, there is substantial variability in prognosis and a subset of patients enjoy survival times well beyond 1 year (3, 4). It is this group of patients that would have the greatest benefit from an initial approach of SRS alone. Patients who underwent surgical resection followed by SRS to the resection bed were included. Local failure was defined as an enlarging, contrast-enhancing lesion on follow-up MRI at the site of SRS treatment. Disease variables included presence of neurological symptoms, number and location of brain metastases, size of the largest brain metastasis, and the presence and status of extracranial metastatic disease. Chi-square or Fisher’s Exact Tests were used to compare groups based on gender, race, smoking status, neurological symptoms, RPA class, prior surgical resection, location of brain metastases, primary histology, primary disease status, and extracranial disease status. Patients who lived beyond 1 year without WBRT had a median survival of almost 3 years, and only 21% eventually required salvage WBRT. In recent years, the oligometastatic disease state has gained much interest, as these patients have a more favorable prognosis compared to other stage IV patients (18, 19). Furthermore, recent data suggest that molecular subtypes of breast cancer are important in predicting survival, as well as CNS control after SRS alone (28, 29).
With each type of cancer (breast, pancreatic, brain, etc) there are a multitude of things going wrong that leads to a cell that loses its stability.
Your body cannot get the nutrition it needs to function at its highest level to destroy the carcinogenic cells.
So ultimately, if you live long enough, and old age doesn’t kill you, cancer will usually be you’re grim.
The five-year results of our study show that the combination of high-dose external radiotherapy utilizing new technologies, such as IMRT, VAMT and IGRT, and 28 months of hormone therapy are a very successful combination to achieve positive prostate cancer control. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. After controlling for covariates, asymptomatic presentation, breast primary, single brain metastasis, absence of extracranial metastases, and oligometastatic disease burden remained independent predictors for favorable WBRT-free survival. The aim of this study is to identify patient, disease, and treatment variables that are associated with prolonged survival free from salvage WBRT.
The rates of local failure, distant CNS failure, salvage treatments, and overall survival were evaluated.
Target lesions were identified using high-resolution magnetic resonance imaging (MRI) with intravenous gadolinium contrast.
Controlled systemic disease was defined as stable or responding disease on most recent imaging prior to SRS.


Based on the independent variables that were significantly associated with 1-year WBRT-free survival on univariate analysis, a multivariate binary logistic regression analysis was performed.
One hundred and four patients (34%) survived beyond 1 year without the need for salvage WBRT, while 56 patients (18%) either died or required WBRT within 3 months. For the group of patients with potential for long-term survival, late treatment-related neurocognitive morbidity of WBRT must be considered (10–13).
It is important to note that the rate of salvage WBRT is dependent on the criteria used to offer salvage WBRT as compared with other salvage options such as repeat SRS.
In our study, oligometastatic disease was strongly associated with longer WBRT-free survival in both univariate and multivariate analyses. Similarly, patients with widespread disease might be more optimally managed with the upfront incorporation of WBRT.
Of paramount consideration, LTAD therapy in combination with HDRT provides good quality of life through a non-invasive, safe and efficient treatment approach for patients with high-risk prostate cancer,” lead study author Almudena Zapatero, MD, PhD, a radiation oncologist at Hospital Universitario de la Princesa in Madrid Spain said in an ASTRO press release. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Among eligible patients (N = 308), two groups with the most divergent outcomes were selected for comparison.
Distant CNS failure was defined as a new contrast-enhancing lesion outside of the SRS treatment volume. Patients who were treated at initial cancer diagnosis were considered to have stable disease as they have not had an opportunity for systemic therapy. Figure 1 shows the survival curve for the entire group of 308 patients treated with SRS alone and the survival curve for the 104 patients that form the subgroup with ≥1 year WBRT-free survival.
Three randomized phase III trials have evaluated SRS alone compared with WBRT and SRS (5–7). A more recent analysis seeking to better stratify patients is the disease-specific graded prognostic assessment (DS-GPA) (4).
In our cohort, repeat SRS was offered only for patients with limited (≤4) new metastases and life-expectancy of at least 3 months, the same criteria as primary treatment. They showed that patients with prolonged survival were significantly more likely to have fewer brain lesions, higher initial performance status, and less extracranial disease. In the favorable group, over three quarters of the patients had oligometastatic disease compared to only one-third in the poor prognosis group. Although a larger, prospective cohort of patients needs to be studied to confirm these findings, the identified predictive variables can be used to compliment and improve multi-disciplinary decision-making. The first group was defined as patients who survived and did not require salvage WBRT for at least 1 year following SRS (N = 104). Dose was prescribed based on tumor size according to Radiation Oncology Therapy Group (RTOG) study 90–05 (16). The comparison groups had similar SRS doses prescribed for the patients’ largest metastases.
The RPA and DS-GPA scoring systems were developed based on patients who were primarily treated with WBRT and not with SRS alone.
The second group consisted of patients with poor outcomes, which was defined as patients who either died or required salvage WBRT within 3 months of SRS (N = 56).
The median dose to the tumor margin was 20 Gy (range 14–22) generally prescribed to the 50% isodose line.
RTOG recursive partitioning analysis (RPA) classification was also determined for each patient (3).
Two other groups have developed predictive models using large databases of patients treated solely with SRS (14, 15). Additionally, given the potential acute and late side effects of adding WBRT, it would be ideal to identify a patient cohort that is likely to achieve prolonged survival and yet unlikely to gain benefit from WBRT.
Although the aforementioned prognostic systems were based on large numbers of patients and have been validated to estimate overall survival, they do not predict the likelihood of regional failure or the need for salvage WBRT. A median time to distant CNS failure of only 3 months was seen in our experience treating patients with >10 lesions (23).
We, therefore, have not offered routine salvage SRS for patients with >4 metastases.
Histology (melanoma and HER2 negative breast cancer), progressive systemic disease, number of metastases (4–13 vs. 1–3), and occult metastases at time of SRS were found to be predictive of early time to distant CNS failure. Our data are consistent with these studies, showing that active disease burden, both in the brain and systemically, is the most influential predictor of WBRT-free survival.




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