Publications by authors named "Almudena Zapatero"

Article Synopsis
  • - Tumor immune microenvironment (TIME) significantly influences how prostate cancer (PC) responds to treatments and understanding mechanisms of resistance is crucial.
  • - Research indicates that certain genomic changes, like microsatellite instability (MSI) and CDK12 bi-allelic loss, may increase response rates to immune therapies, but patient responses vary widely.
  • - The review explores how immune cell interactions within tumors affect PC progression, how standard therapies impact immune responses, and the challenges in analyzing the immune landscape related to tumors.
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Article Synopsis
  • Innovations in advanced prostate cancer have improved outcomes, but there's still a lack of high-level evidence in clinical management, prompting the 2024 Advanced Prostate Cancer Consensus Conference to survey experts for insights.
  • A panel of 120 international experts developed and voted on 183 consensus questions through a web-based survey prior to the conference, defining consensus as ≥75% agreement.
  • The voting results highlight areas of agreement and disagreement that can guide clinical decisions and future research, with a focus on individualizing treatment based on patient characteristics and encouraging participation in clinical trials.
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Purpose: SBRT-Spanish Group-05 (ClinicalTrials.gov.Identifier: NCT02192788) is a collaborative (SBRT-SG, Grupo de Investigación Clínica en Oncología Radioterápica, and Sociedad Española de Oncología Radioterápica) prospective multicenter phase II trial testing stereotactic body radiation therapy (SBRT) and androgen deprivation therapy (ADT) in patients with oligorecurrent prostate cancer.

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Background: Stereotactic ablative body radiotherapy (SABR) is an emerging treatment alternative for patients with localized low and intermediate risk prostate cancer patients. As already explored by some authors in the context of conventional moderate hypofractionated radiotherapy, focal boost of the index lesion defined by magnetic resonance imaging (MRI) is associated with an improved biochemical outcome. The objective of this phase II trial is to determine the effectiveness (in terms of biochemical, morphological and functional control), the safety and impact on quality of life, of prostate SABR with MRI guided focal dose intensification in males with intermediate and high-risk localized prostate cancer.

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Article Synopsis
  • The study aimed to assess how the prostate-specific antigen (PSA) levels six months after radiotherapy affect the prognosis of patients treated with radiotherapy alone or along with short- or long-term androgen-deprivation therapy (ADT).
  • Data were collected from 16 clinical trials involving localized prostate cancer patients, analyzing their PSA levels and their association with metastasis-free survival (MFS), prostate cancer-specific mortality (PCSM), and overall survival (OS) twelve months post-treatment.
  • Results showed higher PSA levels (≥0.1 ng/mL) after treatment were linked to poorer MFS, OS, and higher PCSM rates across all treatment groups, indicating that PSA levels can help in making treatment decisions and designing future clinical trials
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Background: Treatment recommendations for patients with limited nodal recurrences are lacking, and different locoregional treatment approaches are currently being used.

Objective: The aim of this trial is to compare metastasis-directed therapy (MDT) with or without elective nodal pelvic radiotherapy (ENRT).

Design, Setting, And Participants: PEACE V-Salvage Treatment of OligoRecurrent nodal prostate cancer Metastases (STORM) is an international, phase 2, open-label, randomized, superiority trial (ClinicalTrials.

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Background: The European Society for Radiotherapy & Oncology (ESTRO) Advisory Committee for Radiation Oncology Practice (ACROP) panel on prostate bed delineation reflected on macroscopic local recurrences in patients referred for postoperative radiotherapy (PORT), a challenging situation without standardized approach, and decided to propose a consensus recommendation on target volume selection and definition.

Methods: An ESTRO ACROP contouring consensus panel consisting of 12 radiation oncologists and one radiologist, all with subspecialty expertise in prostate cancer, was established. Participants were asked to delineate the prostate bed clinical target volumes (CTVs) in two separate clinically relevant scenarios: a local recurrence at the seminal vesicle bed and one apically at the level of the anastomosis.

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Article Synopsis
  • The study investigates whether biochemical recurrence (BCR) can predict overall survival (OS) in localized prostate cancer by analyzing patient data from 11 clinical trials focused on various treatment methods.* -
  • Results showed that while treatment methods like short-term androgen deprivation therapy (ADT) improved cancer outcomes, there was no significant treatment impact on OS when adjusting for BCR after 48 months.* -
  • The correlation between BCR-free survival and OS was moderate, with Kendall's tau values demonstrating a range between 0.59 and 0.69, indicating a potential relationship but underscoring the complexity of predicting overall survival based on BCR.*
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Within the oligometastatic state, oligorecurrent lymph node disease in prostate cancer represents an interesting clinical entity characterized by a relatively indolent biology that makes it unique: it can be treated radically, and its treatment is usually associated with a long period of control and excellent survival. Additionally, it is an emergent situation that we are facing more frequently mainly due to (a) the incorporation into clinical practice of the PSMA-PET that provides strikingly increased superior images in comparison to conventional imaging, with higher sensitivity and specificity; (b) the higher detection rates of bone and node disease with extremely low levels of PSA; and (c) the availability of high-precision technology in radiotherapy treatments with the incorporation of stereotaxic body radiotherapy (SBRT) or stereotaxic ablative radiotherapy (SABR) technology that allows the safe administration of high doses of radiation in a very limited number of fractions with low toxicity and excellent tolerance. This approach of new image-guided patient management is compelling for doctors and patients since it can potentially contribute to improving the clinical outcome.

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Purpose/objective: Radiotherapy to the prostate bed is a potentially curative salvage option after radical prostatectomy. Although prostate bed contouring guidelines are available in the literature, important variabilities exist. The objective of this work is to provide a contemporary consensus guideline for prostate bed delineation for postoperative radiotherapy.

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Stereotactic body radiotherapy (SBRT) for patients with metastatic cancer, especially when characterised by a low tumour burden (ie, oligometastatic disease), receiving targeted therapy or immunotherapy has become a frequently practised and guideline-supported treatment strategy. Despite the increasing use in routine clinical practice, there is little information on the safety of combining SBRT with modern targeted therapy or immunotherapy and a paucity of high-level evidence to guide clinical management. A systematic literature review was performed to identify the toxicity profiles of combined metastases-directed SBRT and targeted therapy or immunotherapy.

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Background: Innovations in imaging and molecular characterisation and the evolution of new therapies have improved outcomes in advanced prostate cancer. Nonetheless, we continue to lack high-level evidence on a variety of clinical topics that greatly impact daily practice. To supplement evidence-based guidelines, the 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) surveyed experts about key dilemmas in clinical management.

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Article Synopsis
  • The study explores how the timing of androgen-deprivation therapy (ADT) relative to radiotherapy (RT) affects outcomes for prostate cancer, particularly comparing prostate-only RT (PORT) and whole-pelvis RT (WPRT).
  • Researchers analyzed data from 12 randomized trials involving 7,409 patients and utilized advanced statistical methods to assess the impact of ADT sequencing on metastasis-free survival and overall survival.
  • Findings indicated that for patients receiving PORT, concurrent/adjuvant ADT resulted in better metastasis-free survival and lower rates of prostate cancer-specific mortality, whereas WPRT showed no significant differences in outcomes based on ADT timing.
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Background And Purpose: Oligometastatic prostate cancer is a new and emerging treatment field with only few prospective randomized studies published so far. Despite the lack of strong level I evidence, metastasis-directed therapies (MDT) are widely used in clinical practice, mainly based on retrospective and small phase 2 studies and with a large difference across centers. Pending results of ongoing prospective randomized trials, there is a clear need for more consistent treatment indications and radiotherapy practices.

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Recommendations regarding transversal topics applicable to bladder cancer patients independent of tumor grade and stage were established by members of the Spanish Oncology Genitourinary Multidisciplinary Working Group (SOGUG). Liquid biopsy in urine and blood samples is useful in the surveillance of non-muscle-invasive and muscle-invasive bladder cancer, respectively. Multiparametric MRI is an accurate, faster and non-invasive staging method overcoming the understaging risk of other procedures.

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Purpose: Aim of this study is to report the results of the radiotherapy quality assurance program of the PEACE V-STORM randomized phase II trial for pelvic nodal oligorecurrent prostate cancer (PCa).

Material And Methods: A benchmark case (BC) consisting of a postoperative case with 2 nodal recurrences was used for both stereotactic body radiotherapy (SBRT, 30 Gy/3 fx) and whole pelvic radiotherapy (WPRT, 45 Gy/25 fx + SIB boost to 65 Gy).

Results: BC of 24 centers were analyzed.

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Article Synopsis
  • A network meta-analysis was conducted using data from 13 randomized trials involving 11,862 prostate cancer patients to evaluate the effects of radiotherapy dose escalation combined with short-term or long-term androgen deprivation therapy (ADT).
  • The primary focus was on metastasis-free survival (MFS), with findings indicating that long-term ADT provided the most significant improvement in outcomes compared to RT dose escalation alone.
  • Ultimately, while RT dose escalation did not enhance MFS, adding STADT or LTADT consistently improved MFS, with high-dose RT combined with LTADT emerging as the most effective strategy for biochemical recurrence-free survival (BCRFS) and overall outcomes.
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Article Synopsis
  • There have been improvements in treating advanced prostate cancer, but some areas still need more research and evidence to help doctors make the best choices.
  • In 2021, experts gathered for a conference to vote on important questions about treating advanced prostate cancer, focusing on three big topics that people often disagree on.
  • The results of their votes can give helpful guidance to doctors and patients, but each person's treatment should still be based on their specific situation.
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Background: The optimal duration of androgen deprivation combined with high-dose radiotherapy in prostate cancer remains controversial. The DART 01/05 trial was designed to determine whether long-term androgen deprivation is superior to short-term androgen deprivation when combined with high-dose radiotherapy. The 5-year results showed that 2 years of adjuvant androgen deprivation combined with high-dose radiotherapy significantly improved biochemical control, metastasis, and overall survival, especially in patients with high-risk disease.

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Patients with advanced prostate cancer (APC) may be at greater risk for severe illness, hospitalisation, or death from coronavirus disease 2019 (COVID-19) due to male gender, older age, potential immunosuppressive treatments, or comorbidities. Thus, the optimal management of APC patients during the COVID-19 pandemic is complex. In October 2021, during the Advanced Prostate Cancer Consensus Conference (APCCC) 2021, the 73 voting members of the panel members discussed and voted on 13 questions on this topic that could help clinicians make treatment choices during the pandemic.

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