MedicalResearch.com Interview with:
Jason Alexander Efstathiou, D., PH.D
Director, Genitourinary Division
Department of Radiation Oncology
Clinical Co-Director, The Claire and John Bertucci Center for Genitourinary Cancers Multidisciplinary Clinic
Massachusetts General Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: When surgery has probably failed to cure a patient, the best prospective data supports the use of postoperative radiation therapy.
The debate now centers on the optimal timing of such post-prostatectomy radiation therapy; is it adjuvant (ART) for all (with adverse pathologic features) or early salvage (ESRT) for some (who experience biochemical failure)?
MedicalResearch.com: What should readers take away from your report?
Response: National practice patterns show us that the use of ART remains low (estimated at <10% of patients who meet the criteria of having adverse pathologic features).
Our multi-institutional data suggests some benefit to ART (over ESRT), though these findings require validation in ongoing prospective studies. If indeed validated, contemporary practice patterns would need to be revisited
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Emerging genomic biomarkers and advanced imaging may help with risk stratification and patient/treatment selection for ART and ESRT. Ultimately, the onus is on the uro-oncology team (urologist, radiation oncologist, medical oncologist) to discuss postoperative radiation therapy with the patient, address optimal timing when it is used based on the best available data, and provide justification when it is not.
Hwang WL, Tendulkar RD, Niemierko A, Agrawal S, Stephans KL, Spratt DE, Hearn JW, Koontz BF, Lee WR, Michalski JM, Pisansky TM, Liauw SL, Abramowitz MC, Pollack A, Moghanaki D, Anscher MS, Den RB, Zietman AL, Stephenson AJ, Efstathiou JA. Comparison Between Adjuvant and Early-Salvage Postprostatectomy Radiotherapy for Prostate Cancer With Adverse Pathological Features. JAMA Oncol. Published online January 25, 2018. doi:10.1001/jamaoncol.2017.5230
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