Prostatic Neoplasms: Roach M

Mohler J, Babaian RJ, Bahnson RR, Boston B, D'Amico A, Eastham JA, Hauke RJ, Huben RP, Kantoff P, Kawachi M, Kuettel M, Lange PH, Logothetis C, MacVicar G, Pollack A, Pow-Sang JM, Roach M, Sandler H, Shrieve D, Srinivas S, Twardowski P, Urban DA, Walsh PC, Anonymous00332. · No affiliation provided · J Natl Compr Canc Netw. · Pubmed #17692170 No free full text.

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Scher HI, Eisenberger M, D'Amico AV, Halabi S, Small EJ, Morris M, Kattan MW, Roach M, Kantoff P, Pienta KJ, Carducci MA, Agus D, Slovin SF, Heller G, Kelly WK, Lange PH, Petrylak D, Berg W, Higano C, Wilding G, Moul JW, Partin AN, Logothetis C, Soule HR. · Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. · J Clin Oncol. · Pubmed #14752077 No free full text.

Abstract: PURPOSE: To define methodology to show clinical benefit for patients in the state of a rising prostate-specific antigen (PSA). RESULTS: Hypothesis: A clinical states framework was used to address the hypothesis that definitive phase III trials could not be conducted in this patient population. Patient Population: The Group focused on men with systemic (nonlocalized) recurrence and a defined risk of developing clinically detectable metastases. Models to define systemic versus local recurrence, and risk of metastatic progression were discussed. Intervention: Therapies that have shown favorable effects in more advanced clinical states; meaningful biologic surrogates of activity linked with efficacy in other tumor types; and/or effects on a target or pathway known to contribute to prostate cancer progression in this state can be considered for evaluation. Outcomes: An intervention-specific posttherapy PSA-based outcome definition that would justify further testing should be described at the outset. Reporting: Trial reports should include a table showing the number of patients who achieve a specific PSA-based outcome, the number who remain enrolled onto the trial, and the number who came off study at different time points. The term PSA response should be abandoned. Trial Design: The phases of drug development for this state are optimizing dose and schedule, demonstration of a treatment effect, and clinical benefit. To move a drug forward should require a high bar that includes no rise in PSA in a defined proportion of patients for a specified period of time at a minimum. Agents that do not produce this effect can only be tested in combination. The preferred end point of clinical benefit is prostate cancer-specific survival; the time to development of metastatic disease is an alternative. CONCLUSION: Methodology to show that an intervention alters the natural history of prostate cancer is described. At each stage of development, only agents with sufficient activity should be moved forward.

Bahnson RR, Hanks GE, Huben RP, Kantoff P, Kozlowski JM, Kuettel M, Lange PH, Logothetis C, Pow-Sang JM, Roach M, Sandler H, Scardino PT, Taylor RJ, Urban DA, Walsh PC, Wilson TG, Anonymous00207. · James Cancer Hospital and Solove Research Institute at Ohio State University, Columbus, Ohio, USA. · Oncology (Williston Park). · Pubmed #11195405 No free full text.

Abstract: Systemic therapies for prostate cancer are likely to improve, and as they do, they will have enormous impact on the treatment of high-risk and locally advanced cancers. Further technical improvements in radiotherapy and alternative local modalities, such as cryoablation, are also likely, and will bring even more options for local control. It is certain these guidelines will continue to evolve.

Roach M. · No affiliation provided · Int J Radiat Oncol Biol Phys. · Pubmed #19147013 No free full text.

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Roach M. · No affiliation provided · Eur Urol. · Pubmed #17997012 No free full text.

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Roach M. · No affiliation provided · Int J Radiat Oncol Biol Phys. · Pubmed #15989992 No free full text.

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Roach M. · No affiliation provided · Int J Radiat Oncol Biol Phys. · Pubmed #15629584 No free full text.

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Roach M. · No affiliation provided · Int J Radiat Oncol Biol Phys. · Pubmed #14575819 No free full text.

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Roach M. · No affiliation provided · Int J Radiat Oncol Biol Phys. · Pubmed #12654420 No free full text.

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Roach M. · No affiliation provided · Cancer. · Pubmed #12124818 links to  free full text

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Roach M. · No affiliation provided · CA Cancer J Clin. · Pubmed #11188755 links to  free full text

Abstract: The choice of treatment for clinically organ-confined prostate cancer is complicated by the fact that there are no studies demonstrating the clear superiority of one option. As a radiation oncologist who performs both external beam radiotherapy and brachytherapy, Dr. Roach provides a fascinating and balanced perspective on how he views the selection process, as well as how he approaches a decision.

Roach M, Hsu I. · No affiliation provided · Urology. · Pubmed #10962310 No free full text.

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Roach M. · No affiliation provided · Cancer. · Pubmed #10391555 links to  free full text

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Michalski JM, Roach M, Merrick G, Anscher MS, Beyer DC, Lawton CA, Lee WR, Pollack A, Rosenthal SA, Vijayakumar S, Carroll PR. · Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63110-1032, USA. · Int J Radiat Oncol Biol Phys. · Pubmed #19386445 No free full text.

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Chan LW, Xia P, Gottschalk AR, Akazawa M, Scala M, Pickett B, Hsu IC, Speight J, Roach M. · Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA 94115, USA. · Int J Radiat Oncol Biol Phys. · Pubmed #18342454 No free full text.

Abstract: PURPOSE: Although several institutions have reported rectal dose constraints according to threshold toxicity, the plethora of trials has resulted in multiple, confusing dose-volume histogram recommendations. A set of standardized, literature-based constraints for patients undergoing whole pelvic radiotherapy (RT) for prostate cancer would help guide the practice of prostate RT. The purpose of this study was to develop these constraints, demonstrate that they are achievable, and assess the corresponding rectal toxicity. METHODS AND MATERIALS: An extensive literature search identified eight key studies relating dose-volume histogram data to rectal toxicity. A correction factor was developed to address differences in the anatomic definition of the rectum across studies. The dose-volume histogram constraints recommended by each study were combined to generate the constraints. The data from all patients treated with definitive intensity-modulated RT were then compared against these constraints. Acute rectal toxicity was assessed. RESULTS: A continuous, proposed rectal dose-constraint curve was generated. Intensity-modulated RT not only met this constraint curve, but also was able to achieve at least 30-40% lower dose to the rectum. The preliminary clinical results were also positive: 50% of patients reported no acute bowel toxicity, 33% reported Grade 1 toxicity, and 17% reported Grade 2 toxicity. No patients reported Grade 3-4 acute rectal toxicity. CONCLUSIONS: In this study, we developed a set of proposed rectal dose constraints. This allowed for volumetric assessment of the dose-volume relationship compared with single dose-volume histogram points. Additional research will be performed to validate this threshold as a class solution for rectal dose constraints.

D'Ambrosio DJ, Pollack A, Harris EE, Price RA, Verhey LJ, Roach M, Demanes DJ, Steinberg ML, Potters L, Wallner PE, Konski A. · Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA. · Int J Radiat Oncol Biol Phys. · Pubmed #18262085 No free full text.

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Roach M. · Department of Radiation Oncology and Urology, University of California San Francisco, UCSF Comprehensive Cancer Center, San Francisco 94143-1708, USA. · Strahlenther Onkol. · Pubmed #18167004 No free full text.

Abstract: PURPOSE: Several randomized trials have demonstrated that men with localized prostate cancer benefit from the use of short-term neoadjuvant androgen deprivation therapy (NADT) in combination with external beam radiotherapy (EBRT), while other trials have shown improved outcomes with higher doses of radiation. This review compares both approaches and the rationale for using both. MATERIALS AND METHODS: To date 4 randomized trials, including 10 arms and approximately 1600 men have reported comparing patients treated with EBRT alone to EBRT combined with short-term NADT. To date, four Phase III dose escalation trials have been completed including 8 arms and a total of approximately 2210 patients with doses up to 74 to 79 Gy compared to doses of 64 to 70 Gy on the control arms. RESULTS: All studies (n = 4) using NADT demonstrated an improvement in biochemical failure compared to patients treated with EBRT alone, three studies showed an improvement in cause specific survival and one showed an overall survival advantage, one showed a reduction in distant metastasis or the need for salvage ADT. All phase III dose escalation studies to date only show an improvement in biochemical control. CONCLUSIONS: The quality of the evidence supporting the use of NADT in combination with EBRT for clinically important endpoints is stronger than the data supporting dose escalation. Cure rates appear to be unacceptably low for both approaches such that higher doses of EBRT combined with NADT and whole pelvic radiotherapy may be indicated for optimal outcomes.

Sahgal A, Roach M. · Odette Cancer Center of the Sunnybrook Health Sciences Center, University of Toronto, Ontario, Canada. · Nat Clin Pract Urol. · Pubmed #18059346 No free full text.

Abstract: This Review highlights current areas of controversy and development in the field of transperineal permanent prostate seed implantation brachytherapy (PPI), in particular the technological evolution of PPI treatment planning that has led to intra-operative treatment planning and execution, the use of MRI spectroscopy and ultrasonography to target intraprostatic tumor foci, and the introduction of (131)Cs as a new PPI isotope. Here we present a comprehensive review of mature data for PPI monotherapy and PPI combined with supplemental external beam radiation therapy, and a critical discussion of issues pertinent to supplemental EBRT. We also present our current policies in the treatment of prostate cancer at the University of California, San Francisco.

Meyer JL, Leibel S, Roach M, Vijayakumar S. · Department of Radiation Oncology, Saint Francis Memorial Hospital, San Francisco, CA 94109, USA. · Front Radiat Ther Oncol. · Pubmed #17641517 No free full text.

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Zapotoczna A, Sasso G, Simpson J, Roach M. · Department of Radiation Oncology, Townsville Teaching Hospital, Queensland, Australia. · Neoplasia. · Pubmed #17603627 links to  free full text

Abstract: Prostatic neoplasms are not uniformly distributed within the prostate volume. With recent developments in three-dimensional intensity-modulated and image-guided radiation therapy, it is possible to treat different volumes within the prostate to different thresholds of doses. This approach has the potential to adapt the dose to the biologic aggressiveness of various clusters of tumor cells within the gland. The definition of tumor burden volume in prostate cancer can be facilitated by the use of magnetic resonance spectroscopy (MRS). The increasing sensitivity and specificity of MRS to the prostate is causing new interest in its potential role in the definition of target subvolumes at higher risk of failure following radical radiotherapy. Prostate MRS might also play a role as a noninvasive predictive factor for tumor response and treatment outcome. We review the use of MRS in radiation therapy for prostate cancer by evaluating its accuracy in the classification of aggressive cancer regions and target definition; its current role in the radiotherapy planning process, with special interest in technical issues behind the successful inclusion of MRS in clinical use; and available early experiences as a prognostic tool.

Speight JL, Roach M. · Department of Radiation Oncology, University of California San Francisco, Comprehensive Cancer Center, San Francisco, CA 94115-1708, USA. · J Clin Oncol. · Pubmed #17350948 No free full text.

Abstract: Radiation therapy is an active modality in the management of local and regional prostate cancer, but can be curative only if all existing disease is encompassed within the treatment portal. In addition to the ability to deliver sufficient radiation dose, accurate targeting is critical to achieve better treatment outcomes. Failure to accommodate daily variations in setup and organ motion potentially limits the efficacy of sophisticated conformal techniques (three-dimensional conformal radiotherapy and intensity-modulated radiotherapy). Increased use of various online and real-time imaging techniques is an important step toward enhancing treatment accuracy. The incorporation of functional imaging techniques into treatment planning is another important step. The addition of biologic and metabolic information regarding the location and extent of disease combined with real-time online imaging will allow us to better determine where, how, and with what to treat appropriate targets and improve cure rates.

Bermudez RS, Izaguirre A, Roach M. · University of California, San Francisco, Department of Radiation Oncology, 1600 Divisadero Street, Suite number H1031, San Francisco, CA 94115, USA. · Future Oncol. · Pubmed #17280507 No free full text.

Abstract: Four Phase III trials demonstrating higher prostate-specific antigen control rates in prostate cancer patients treated with higher doses of radiation have changed the standard of care. Emerging on-line technologies, improved imaging and computer algorithms, combined with an improved understanding of how best to apply them, have allowed radiation oncologists to move ever closer to the optimal application of curative radiation. This technology allows a higher dose to be delivered to tumor-bearing areas while minimizing the dose delivered to surrounding normal tissues. Real-time adaptive techniques have made each step more accurate, and commercialization has increasingly moved these advances further into the community setting. Phase III trials have also helped to define the role of hormonal therapy in combination with radiation and the benefits of prophylactic pelvic nodal radiotherapy in subsets of patients. We have also learnt how to optimize the use of prostate-specific antigen to better determine success and failure following radiotherapy.

Chan LW, Roach M. · Department of Radiation Oncology, UCSF Comprehensive Cancer Center, San Francisco, CA 94143-1708, USA. lindachan@radonc,ucsf.edu · Minerva Urol Nefrol. · Pubmed #17268397 No free full text.

Abstract: Treatment of prostate cancer is extremely controversial because of the lack of evidence that most patients benefit from treatment. This general rule, however, does not apply to patients with unfavorable risk prostate cancer. There is a large body of literature that suggests that intervention impacts the natural history of patients with unfavorable risk prostate cancer. Thus, there are essentially no experts that would argue that such patients do not need to be treated. Controversies arise, however, as to what is the best treatment of patients with unfavorable risk prostate cancer. Before addressing this issue, however, it is critical to define unfavorable risk prostate cancer.

Roach M, Izaguirre A. · Department of Radiation Oncology, University of California San Francisco, UCSF Comprehensive Cancer Center, San Francisco, California 94143-1708, USA. · Expert Opin Pharmacother. · Pubmed #17257094 No free full text.

Abstract: Improvements in longer-term survival rates have been demonstrated for locally advanced prostate cancer patients treated with adjuvant androgen deprivation therapy (ADT), and in subsets of men with clinically localized disease treated with ADT combined with external-beam radiotherapy (RT). In these studies, ADT was administered in the form of surgery (orchiectomy) or with a class of drugs called luteinizing hormone-releasing hormone agonists. Goserelin acetate is a member of this class, and 10 of 11 major Phase III trials demonstrating better outcomes with ADT and RT used goserelin acetate. The reduction in deaths from prostate cancer noted in the mid-1990s may largely be due to the early use of these agents in men with intermediate-to-high-risk disease.

Speight JL, Roach M. · Department of Radiation Oncology, University of California San Francisco Comprehensive Cancer Center, H1031, 1600 Divisadero Street, San Francisco, CA 94143, USA. · Hematol Oncol Clin North Am. · Pubmed #16730297 No free full text.

Abstract: A continued role for radiation therapy in the multidisciplinary management of genitourinary malignancies seems certain. Treatment outcomes continue to improve, accompanied by diminishing rates of toxicity. With continued technologic advances in the delivery of radiation, including the use of adaptive radiotherapy, the discovery and application of novel treatment agents, and the combined efforts of urologists, medical oncologists, and radiation oncologists, patients who have genitourinary malignancies have an excellent chance of cure.