David Pfister

Publications (3)10.82 Total impact

• Article: Local prostate cancer radiotherapy -after prostate-specific antigen progression during primary hormonal therapy.

  Michael Pinkawa, Marc D Piroth, Richard Holy, Victoria Djukic, Jens Klotz, David Pfister, Axel Heidenreich, Michael J Eble
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  ABSTRACT: BACKGROUND: The outcome of patients after radiotherapy (RT) for localized prostate cancer in case of prostate-specific antigen (PSA) progression during primary hormonal therapy (HT) is not well known. METHODS: A group of 27 patients presenting with PSA progression during primary HT for local prostate cancer RT was identified among patients who were treated in the years 2000--2004 either using external-beam RT (EBRT; 70.2Gy; n=261) or Ir-192 brachytherapy as a boost to EBRT (HDR-BT; 18Gy + 50.4Gy; n=71). The median follow-up period after RT was 68 months. RESULTS: Median biochemical recurrence free (BRFS), disease specific (DSS) and overall survival (OS) for patients with PSA progression during primary HT was found to be only 21, 54 and 53 months, respectively, with a 6-year BRFS, DSS and OS of 19%, 41% and 26%. There were no significant differences between different RT concepts (6-year OS of 27% after EBRT and 20% after EBRT with HDR-BT).Considering all 332 patients in multivariate Cox regression analysis, PSA progression during initial HT, Gleason score>6 and patient age were found to be predictive for lower OS (p<0.001). The highest hazard ratio resulted for PSA progression during initial HT (7.2 in comparison to patients without PSA progression during primary HT). PSA progression and a nadir >0.5ng/ml during initial HT were both significant risk factors for biochemical recurrence. CONCLUSIONS: An unfavourable prognosis after PSA progression during initial HT needs to be considered in the decision process before local prostate radiotherapy. Results from other centres are needed to validate our findings.
  Radiation Oncology 12/2012; 7(1):209. · 2.32 Impact Factor
• Article: Surgical resection of urological tumor metastases following medical treatment.

  Axel Heidenreich, Stefan Wilop, Michael Pinkawa, Daniel Porres, David Pfister
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  ABSTRACT: The rate of systemic metastases is about 20% in testicular germ cell tumors, 25% to 30% in prostate cancer, 30% in urothelial carcinoma with muscle invasion, and 50% in renal-cell carcinoma. This article is a critical review of current data on the resection of metastases of urological tumors after systemic drug treatment. Review of pertinent publications retrieved by a selective literature search. No pertinent prospective, randomized trials, meta-analyses, or Cochrane reviews have been published. The publications available for review include guidelines and retrospective studies with evidence levels ranging from IIB to III. For non-seminomatous germ cell tumors with tumor markers that are negative or have reached a plateau after chemotherapy, resection of retroperitoneal, intra-abdominal, and intrathoracic metastases with curative intent is now the treatment of choice at clinical reference centers. For urothelial carcinoma that has gone into partial remission after systemic chemotherapy, with full resectability, the resection of metastases prolongs survival from about 13 months to 31-41 months. For prostatic carcinoma with solitary, intrapelvic lymph-node metastases and PSA less than 4 ng/mL, the resection of metastases prolongs 5-year progression-free survival in 40% to 50% of cases. There is, however, no indication for the resection of retro-peritoneal, visceral, or bony metastases. In renal-cell carcinoma, the resection of pulmonary or hepatic metastases is associated with a 5-year survival rate of 40% to 50% or 62%, respectively, and should thus be made a component of the treatment plan for this disease. The indication for resecting metastases of urological cancers should always be established by an interdisciplinary tumor board in the light of the existing scientific evidence. The resection of metastases of some types of urological cancer after chemotherapy can prolong progression-free and overall survival. This form of treatment deserves consideration as a component of individual care and of the interdisciplinary treatment plan for urological cancers.
  09/2012; 109(39):631-7. · 2.92 Impact Factor
• Article: Urinary morbidity after permanent prostate brachytherapy - impact of dose to the urethra vs. sources placed in close vicinity to the urethra.

  Michael Pinkawa, Richard Holy, Marc D Piroth, Jens Klotz, David Pfister, Axel Heidenreich, Michael J Eble
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  ABSTRACT: The impact of the dose to the urethra and sources placed close to the urethra on urinary morbidity after permanent prostate brachytherapy (PPB) is not well known. Fifty-nine patients were surveyed prospectively before treatment (A), 1 month after (B) and > 1 year after PPB (C) using a validated questionnaire (Expanded Prostate Cancer Index Composite). Computed tomography (CT) postimplant scans were performed at days 1 (Foley catheter in situ) and 30 after PPB and sources within 5mm of the urethra at day 1 were identified. As opposed to the urethral dose-volume histogram, a larger number of sources within 5mm of the urethra at day 1 predicted significantly larger urinary bother score changes at times B and C - with an impact on incontinence and frequency (e.g. moderate/big problem with leaking urine in 25% vs. 3%, p = 0.02; moderate/big problem with frequent urination in 33% vs. 7%, p < 0.01, at time C with vs. without ≥ 3 sources in a single strand placed close to the urethra). Placement of sources with a minimum distance of a few mm to the urethra should be a major aim to avoid urinary morbidity irrespective of the urethral dose-volume histogram.
  Radiotherapy and Oncology 01/2012; 103(2):247-51. · 5.58 Impact Factor