Radiotherapy for Genitourinary Cancer

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Genitourinary Oncology".

Deadline for manuscript submissions: 15 July 2024 | Viewed by 17696

Special Issue Editors


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Guest Editor
Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Interests: radiation oncology; intensity-modulated radiation therapy; prostate cancer; head and neck cancer; cervical cancer; outcomes research

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Guest Editor
Department of Urology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
Interests: muscle-invasive bladder cancer; prostate cancer; oligometastasis; robot-assisted surgery; intracorporeal urinary diversion; ileal neobladder; ileal conduit
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Special Issue Information

Dear Colleagues,

Radiation therapy is one of the most important treatment modalities for genitourinary cancer. In addition to definitive radiation therapy for primary lesions, palliative radiation therapy of metastatic lesions for pain relief is also performed, especially for prostate cancer. In recent years, attempts have been made to improve the prognosis of patients with metastatic cancer by using radiation therapy to target the primary tumor.

Recently, various radiation therapy methods have also been developed and favorable outcomes have been reported. At present, however, it is not clear which treatment method should be selected for which type of cancer and what dosage should be used. On the other hand, there have been attempts to improve patients’ prognosis by combining radiotherapy with systemic treatment.

Radiation therapy is certainly an effective treatment for genitourinary cancer. However, it is also true that there are many aspects that are yet to be elucidated. In addition, biomarkers used for predicting treatment efficacy are currently being extensively studied. Conversely, the definition of recurrence when using tumor markers differs between surgical therapy and radiation therapy, which causes significant issues.

In this Special Issue, we invite you to discuss various topics related to radiotherapy, such as treatment outcomes, biomarkers used to predict diagnosis and treatment efficacy, and issues related to the definition of recurrence.

Dr. Natsuo Tomita
Prof. Dr. Takuya Koie
Guest Editors

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Keywords

  • radiation therapy
  • genitourinary cancer
  • definitive therapy
  • palliative therapy
  • radiation and systemic therapy
  • biomarkers
  • diagnosis

Published Papers (10 papers)

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Research

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0 pages, 810 KiB  
Communication
The Role of c-MET as a Biomarker in Patients with Bladder Cancer Treated with Radical Chemo-Radiotherapy
by Hélène Houssiau, Géraldine Pairet, Hélène Dano and Emmanuel Seront
Curr. Oncol. 2023, 30(12), 10550-10555; https://doi.org/10.3390/curroncol30120770 - 18 Dec 2023
Viewed by 1118
Abstract
Background: Bladder cancer is a highly aggressive cancer, and muscle invasive urothelial carcinoma (MIUC) requires aggressive strategy. Concomitant chemo-radiotherapy (CRT) appears as a therapeutic option that allows bladder sparing. No biomarker is currently available to optimally select patients for CRT. Methods: We retrospectively [...] Read more.
Background: Bladder cancer is a highly aggressive cancer, and muscle invasive urothelial carcinoma (MIUC) requires aggressive strategy. Concomitant chemo-radiotherapy (CRT) appears as a therapeutic option that allows bladder sparing. No biomarker is currently available to optimally select patients for CRT. Methods: We retrospectively enrolled patients with MIUC who were treated in a curative setting with CRT. Based on c-MET expression in pre-treatment tumor tissue, patients were stratified into two groups: no expression of c-MET (group A) and expression of c-MET (group B). We evaluated the outcome of these patients based on c-MET expression. Results: After a median follow-up of 40 months, 13 patients were enrolled in this analysis, 8 in group A and 5 in group B. The disease recurrence was 25% in group A and 100% in group B. Compared to group A, patients from group B experienced more frequent and more rapid recurrence in terms of metastases; the 3-year metastatic recurrence rate was 13% and 100%, respectively. The c-MET expression was also associated with a higher rate of cancer-related deaths. Conclusions: In this retrospective analysis, c-MET expression was associated with worse disease-free survival and survival in patients treated radically with CRT. Full article
(This article belongs to the Special Issue Radiotherapy for Genitourinary Cancer)
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11 pages, 568 KiB  
Article
Identification of Early Biochemical Recurrence Predictors in High-Risk Prostate Cancer Patients Treated with Carbon-Ion Radiotherapy and Androgen Deprivation Therapy
by Takanobu Utsumi, Hiroyoshi Suzuki, Hitoshi Ishikawa, Masaru Wakatsuki, Noriyuki Okonogi, Masaoki Harada, Tomohiko Ichikawa, Koichiro Akakura, Yoshitaka Murakami, Hiroshi Tsuji and Shigeru Yamada
Curr. Oncol. 2023, 30(10), 8815-8825; https://doi.org/10.3390/curroncol30100636 - 27 Sep 2023
Cited by 1 | Viewed by 1144
Abstract
The aim of this retrospective study was to identify clinical predictors of early biochemical recurrence (BCR) in patients with high-risk prostate cancer (PCa) treated with carbon-ion radiotherapy (CIRT) and androgen deprivation therapy (ADT). A total of 670 high-risk PCa patients treated with CIRT [...] Read more.
The aim of this retrospective study was to identify clinical predictors of early biochemical recurrence (BCR) in patients with high-risk prostate cancer (PCa) treated with carbon-ion radiotherapy (CIRT) and androgen deprivation therapy (ADT). A total of 670 high-risk PCa patients treated with CIRT and ADT were included in the study. Early BCR was defined as recurrence occurring during adjuvant ADT after CIRT or within 2 years after completion of ADT. Univariate and multivariate analyses were performed to identify clinical predictors of early BCR. Patients were also classified according to the Systemic Therapy in Advancing or Metastatic Prostate cancer (STAMPEDE) PCa classification. Early BCR was observed in 5.4% of the patients. Multivariate analysis identified clinical T3b stage and ≥75% positive biopsy cores as clinical predictors of early BCR after CIRT and ADT. The STAMPEDE PCa classification was also significantly associated with early BCR based on univariate analysis. These predictors can help clinicians identify patients who are at risk of early BCR. In the future, combination therapy of ADT with abiraterone may be an option for high-risk PCa patients who are at risk of early BCR, based on the results of the STAMPEDE study. Full article
(This article belongs to the Special Issue Radiotherapy for Genitourinary Cancer)
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10 pages, 694 KiB  
Article
Associations of Clinical and Dosimetric Parameters with Urinary Toxicities after Prostate Brachytherapy: A Long-Term Single-Institution Experience
by Masaya Ito, Chiyoko Makita, Takayuki Mori, Hirota Takano, Tomoyasu Kumano, Masayuki Matsuo, Koji Iinuma, Makoto Kawase, Keita Nakane, Masahiro Nakano and Takuya Koie
Curr. Oncol. 2023, 30(6), 5680-5689; https://doi.org/10.3390/curroncol30060426 - 09 Jun 2023
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Abstract
To examine the association of clinical, treatment, and dose parameters with late urinary toxicity after low-dose-rate brachytherapy (LDR-BT) for prostate cancer, we retrospectively studied patients with prostate cancer who underwent LDR-BT from January 2007 through December 2016. Urinary toxicity was assessed using the [...] Read more.
To examine the association of clinical, treatment, and dose parameters with late urinary toxicity after low-dose-rate brachytherapy (LDR-BT) for prostate cancer, we retrospectively studied patients with prostate cancer who underwent LDR-BT from January 2007 through December 2016. Urinary toxicity was assessed using the International Prostate Symptom Score (IPSS) and Overactive Bladder (OAB) Symptom Score (OABSS). Severe and moderate lower urinary tract symptoms (LUTS) were defined as IPSS ≥ 20 and ≥ 8, respectively; OAB was defined as a nocturnal frequency of ≥ 2 and a total OABSS of ≥ 3. In total, 203 patients (median age: 66 years) were included, with a mean follow-up of 8.4 years after treatment. The IPSS and OABSS worsened after 3 months of treatment; these scores improved to pretreatment levels after 18–36 months in most patients. Patients with a higher baseline IPSS and OABSS had a higher frequency of moderate and severe LUTS and OAB at 24 and 60 months, respectively. LUTS and OAB at 24 and 60 months were not correlated with the dosimetric factors of LDR-BT. Although the rate of long-term urinary toxicities assessed using IPSS and OABSS was low, the baseline scores were related to long-term function. Refining patient selection may further reduce long-term urinary toxicity. Full article
(This article belongs to the Special Issue Radiotherapy for Genitourinary Cancer)
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10 pages, 1155 KiB  
Article
Dosimetric Predictors of Toxicity after Prostate Stereotactic Body Radiotherapy: A Single-Institutional Experience of 145 Patients
by Kyohei Fujii, Masahiro Nakano, Shogo Kawakami, Yuichi Tanaka, Takuro Kainuma, Hideyasu Tsumura, Ken-ichi Tabata, Takefumi Satoh, Masatsugu Iwamura and Hiromichi Ishiyama
Curr. Oncol. 2023, 30(5), 5062-5071; https://doi.org/10.3390/curroncol30050383 - 16 May 2023
Viewed by 1442
Abstract
The indications for stereotactic body radiotherapy (SBRT) for prostate cancer have increased. However, the relationships between adverse events and risk factors remain unclear. This study aimed to clarify associations between adverse events and dose index for prostate SBRT. Participants comprised 145 patients irradiated [...] Read more.
The indications for stereotactic body radiotherapy (SBRT) for prostate cancer have increased. However, the relationships between adverse events and risk factors remain unclear. This study aimed to clarify associations between adverse events and dose index for prostate SBRT. Participants comprised 145 patients irradiated with 32–36 Gy in 4 fractions. Radiotherapy-related risk factors such as dose-volume histogram parameters and patient-related risk factors such as T stage and Gleason score were evaluated in a competing risk analysis. Median follow-up duration was 42.9 months. A total of 9.7% had acute Grade ≥ 2 GU toxicities and 4.8% had acute Grade ≥ 2 GI toxicities. A total of 11.1% had late Grade ≥ 2 GU toxicities and 7.6% had late Grade ≥ 2 GI toxicities. Two (1.4%) patients suffered from late Grade 3 GU toxicities. Similarly, two (1.4%) patients suffered from late Grade 3 GI toxicities. Acute GU and GI events correlated with prostate volume and dose to the hottest 10 cc volume (D10cc)/volumes receiving a minimum of 30 Gy (V30 Gy) of rectum, respectively. Late GI toxicity, frequency, and rectal hemorrhage correlated with rectal D0.1 cc/D1 cc, maximum dose to the bladder, and rectal D0.1 cc, respectively. Toxicities after prostate SBRT using 32–36 Gy/4 fractions were acceptable. Our analysis showed that acute toxicities correlated with volume receiving a medium dose level, and late toxicities correlated with highest point dose of organs at risk. Full article
(This article belongs to the Special Issue Radiotherapy for Genitourinary Cancer)
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7 pages, 1333 KiB  
Communication
Seed Density as a New Predictive Index of Seed Migration in Brachytherapy for Prostate Cancer Using Iodine-125 Loose Seed
by Takahiro Yamaguchi, Masayuki Matsuo, Takayuki Mori, Yoshifumi Noda, Chiyoko Makita, Fuminori Hyodo, Koji Iinuma, Masahiro Nakano, Takuya Koie and Hidekazu Tanaka
Curr. Oncol. 2023, 30(4), 4060-4066; https://doi.org/10.3390/curroncol30040308 - 04 Apr 2023
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Abstract
Aim: This study aimed to examine the usefulness of seed density as a predictor of seed migration in patients with prostate cancer who received brachytherapy using Iodine-125 loose seed. Methods: From May 2006 to April 2016, 320 patients with localized prostate cancer underwent [...] Read more.
Aim: This study aimed to examine the usefulness of seed density as a predictor of seed migration in patients with prostate cancer who received brachytherapy using Iodine-125 loose seed. Methods: From May 2006 to April 2016, 320 patients with localized prostate cancer underwent transperineal brachytherapy using iodine-125 loose seeds. Among them, 202 (63.1%) patients received brachytherapy monotherapy and 118 (36.9%) received combined brachytherapy and external beam radiotherapy. Seed density was calculated using the following formula: seed density = implanted seed number/prostate volume. All patients underwent radiography of the chest, abdomen and pelvis, and computed tomography at 1 day, 1 month, and 1 year after brachytherapy to evaluate the presence of seed migration. Results: In total, the number of implanted seeds was 21,876. Seed migration was detected in 92 (28.8%) patients. Of a total of 21,876 seeds, 144 (0.66%) showed migration. The number of needles, number of seeds, and seed density were significantly higher in the group with migration than in the group without migration (p = 0.05). The ROC cutoff values for prostate volume, number of needles, number of seeds, and seed density were 20.9 cc, 21, 65, and 3.0, respectively. In the univariate analysis, prostate volume, number of needles, number of seeds, seed density, and treatment modality were all significant factors in predicting migration (p = 0.05). In the multivariate analysis, seed density and treatment modality were significant factors in predicting migration (p = 0.05). Conclusion: Seed density is useful for predicting seed migration. In cases with seed density > 3.0, it is necessary to take measures such as considering the use of stranded seeds. Full article
(This article belongs to the Special Issue Radiotherapy for Genitourinary Cancer)
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9 pages, 834 KiB  
Article
Direct Comparison of Two Different Definitions with Biochemical Recurrence after Low-Dose-Rate Brachytherapy for Prostate Cancer
by Shinichi Takeuchi, Koji Iinuma, Keita Nakane, Masahiro Nakano, Makoto Kawase, Kota Kawase, Manabu Takai, Daiki Kato, Takayuki Mori, Hirota Takano, Tomoyasu Kumano, Masayuki Matsuo and Takuya Koie
Curr. Oncol. 2023, 30(3), 2792-2800; https://doi.org/10.3390/curroncol30030212 - 26 Feb 2023
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Abstract
We aimed to determine whether biochemical recurrence-free survival (BRFS) of patients with prostate cancer (PCa) who received low-dose-rate brachytherapy (LDR-BT) differed according to the definition of biochemical recurrence (BCR) after radical prostatectomy (RP) and the definition given by the Japanese Prostate Cancer Outcome [...] Read more.
We aimed to determine whether biochemical recurrence-free survival (BRFS) of patients with prostate cancer (PCa) who received low-dose-rate brachytherapy (LDR-BT) differed according to the definition of biochemical recurrence (BCR) after radical prostatectomy (RP) and the definition given by the Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation (J-POPS). We reviewed the clinical records of 476 consecutive patients with PCa who received LDR-BT at the Gifu University Hospital. The primary endpoint of this study was the difference in BRFS between the two aforementioned definitions. When the follow-up period ended, 74 (15.5%) and 20 (4.2%) patients had BCR according to the RP and J-POPS definitions, respectively. The 5-year BRFS rates were 85.0% and 96.9% for the RP and J-POPS definitions, respectively (p < 0.005). According to the RP definition, the 5-year BRFS rates were 80.6% in the group aged <63 years and 86.6% in those aged ≥63 years (p = 0.050). According to the J-POPS definition, the 5-year BRFS rates were 94.1% and 97.8% in the groups aged <63 years and ≥63 years, respectively (p = 0.005). The definition of recurrence in LDR-BT may need to be reconsidered. Full article
(This article belongs to the Special Issue Radiotherapy for Genitourinary Cancer)
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Review

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12 pages, 255 KiB  
Review
Clinical Efficacy and Openness to New Challenges of Low Dose Rate Brachytherapy for Prostate Cancer
by Manabu Kato, Shinichiro Higashi, Yusuke Sugino, Shinya Kajiwara, Shiori Tanaka, Goshi Kitano, Yasuhumi Yamashita, Yuji Ogura, Hiroyuki Tachibana, Takahiro Kojima and Takahiro Inoue
Curr. Oncol. 2023, 30(11), 9824-9835; https://doi.org/10.3390/curroncol30110713 - 08 Nov 2023
Viewed by 1147
Abstract
Over a century ago, low-dose-rate (LDR) brachytherapy was introduced to treat prostate cancer (PCa). Since then, it has been widely applied worldwide, including in East Asia. LDR brachytherapy has been performed in 88 institutes in Japan. Beneficial clinical outcomes of LDR brachytherapy for [...] Read more.
Over a century ago, low-dose-rate (LDR) brachytherapy was introduced to treat prostate cancer (PCa). Since then, it has been widely applied worldwide, including in East Asia. LDR brachytherapy has been performed in 88 institutes in Japan. Beneficial clinical outcomes of LDR brachytherapy for intermediate-to-high-risk PCa have been demonstrated in large clinical trials. These clinical outcomes were achieved through advances in methods, such as urological precise needle puncture and seed placement, and the quantitative decision making regarding radiological parameters by radiation oncologists. The combined use of LDR brachytherapy with other therapeutic modalities, such as external beam radiation and androgen deprivation therapy, for the clinical risk classification of PCa has led to better anticancer treatment efficacy. In this study, we summarized basic LDR brachytherapy findings that should remain unchanged and be passed down in urology departments. We also discussed the applications of LDR brachytherapy for PCa in various clinical settings, including focal and salvage therapies. In addition, we highlighted technologies associated with brachytherapy that are under development. Full article
(This article belongs to the Special Issue Radiotherapy for Genitourinary Cancer)
19 pages, 466 KiB  
Review
The Current Trend of Radiation Therapy for Patients with Localized Prostate Cancer
by Kazuyuki Numakura, Mizuki Kobayashi, Yumina Muto, Hiromi Sato, Yuya Sekine, Ryuta Sobu, Yu Aoyama, Yoshiko Takahashi, Syuhei Okada, Hajime Sasagawa, Shintaro Narita, Satoshi Kumagai, Yuki Wada, Naoko Mori and Tomonori Habuchi
Curr. Oncol. 2023, 30(9), 8092-8110; https://doi.org/10.3390/curroncol30090587 - 01 Sep 2023
Cited by 1 | Viewed by 2077
Abstract
A recent approach to radiotherapy for prostate cancer is the administration of high doses of radiation to the prostate while minimizing the risk of side effects. Thus, image-guided radiotherapy utilizes advanced imaging techniques and is a feasible strategy for increasing the radiation dose. [...] Read more.
A recent approach to radiotherapy for prostate cancer is the administration of high doses of radiation to the prostate while minimizing the risk of side effects. Thus, image-guided radiotherapy utilizes advanced imaging techniques and is a feasible strategy for increasing the radiation dose. New radioactive particles are another approach to achieving high doses and safe procedures. Prostate brachytherapy is currently considered as a combination therapy. Spacers are useful to protect adjacent organs, specifically the rectum, from excessive radiation exposure. Full article
(This article belongs to the Special Issue Radiotherapy for Genitourinary Cancer)
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17 pages, 651 KiB  
Review
PSMA Targeted Molecular Imaging and Radioligand Therapy for Prostate Cancer: Optimal Patient and Treatment Issues
by Seiji Hoshi, Kei Yaginuma, Satoru Meguro, Akifumi Onagi, Kanako Matsuoka, Junya Hata, Yuichi Sato, Hidenori Akaihata, Masao Kataoka, Soichiro Ogawa, Motohide Uemura and Yoshiyuki Kojima
Curr. Oncol. 2023, 30(8), 7286-7302; https://doi.org/10.3390/curroncol30080529 - 01 Aug 2023
Cited by 4 | Viewed by 2486
Abstract
Theranostics (therapy + diagnosis) targeting prostate-specific membrane antigen (PSMA) is an emerging therapeutic modality that could alter treatment strategies for prostate cancer. Although PSMA-targeted radioligand therapy (PSMA-RLT) has a highly therapeutic effect on PSMA-positive tumor tissue, the efficacy of PSMA-RLT depends on PSMA [...] Read more.
Theranostics (therapy + diagnosis) targeting prostate-specific membrane antigen (PSMA) is an emerging therapeutic modality that could alter treatment strategies for prostate cancer. Although PSMA-targeted radioligand therapy (PSMA-RLT) has a highly therapeutic effect on PSMA-positive tumor tissue, the efficacy of PSMA-RLT depends on PSMA expression. Moreover, predictors of treatment response other than PSMA expression are under investigation. Therefore, the optimal patient population for PSMA-RLT remains unclear. This review provides an overview of the current status of theranostics for prostate cancer, focusing on PSMA ligands. In addition, we summarize various findings regarding the efficacy and problems of PSMA-RLT and discuss the optimal patient for PSMA-RLT. Full article
(This article belongs to the Special Issue Radiotherapy for Genitourinary Cancer)
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Other

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18 pages, 1579 KiB  
Systematic Review
Adjuvant Radiotherapy for Upper Tract Urothelial Carcinoma: Systematic Review and Meta-Analysis
by Osbert Zalay, Michael Yan, Samantha Sigurdson, Shawn Malone, Francisco Emilio Vera-Badillo and Aamer Mahmud
Curr. Oncol. 2023, 30(1), 19-36; https://doi.org/10.3390/curroncol30010002 - 20 Dec 2022
Cited by 2 | Viewed by 2041
Abstract
Purpose: Upper tract urothelial carcinoma (UTUC) is a rare form of malignancy comprising only 5% of urothelial cancers. The mainstay of treatment is radical nephroureterectomy (RNU) with bladder cuff excision. Neoadjuvant or adjuvant chemotherapy is often used in locally advanced disease. The role [...] Read more.
Purpose: Upper tract urothelial carcinoma (UTUC) is a rare form of malignancy comprising only 5% of urothelial cancers. The mainstay of treatment is radical nephroureterectomy (RNU) with bladder cuff excision. Neoadjuvant or adjuvant chemotherapy is often used in locally advanced disease. The role of adjuvant radiotherapy (RT), however, remains controversial. To further explore the potential role of adjuvant RT, we performed a systematic review and meta-analysis of the literature from 1990 to present. Methods and Materials: We identified 810 candidate articles from database searches, of which 67 studies underwent full-text review, with final inclusion of 20 eligible studies. Among the included studies, there were no randomized controlled trials and a single prospective trial, with the remainder being retrospective series. We performed quantitative synthesis of the results by calculating the pooled odds ratios (OR) for the primary outcome of locoregional recurrence (LRR) and secondary outcomes of overall survival (OS), cancer-specific survival (CSS) and distant recurrence (DR). Results: Adjuvant RT, which was mostly prescribed for locally advanced or margin-positive disease following RNU, significantly reduced locoregional recurrence risk OR 0.43 (95% CI: 0.23–0.70), and the effect remained significant even following subgroup analysis to account for adjuvant systemic therapy. The effect of adjuvant RT on 3-year OS, 5-year CSS and DR was non-significant. However, 5-year OS was unfavourable in the adjuvant RT arm, but study heterogeneity was high, and analysis of small-study effects and subgroups suggested bias in reporting of outcomes. Conclusions: Adjuvant RT in the setting of locally advanced UTUC improves locoregional control following definitive surgery, but does not appear to improve OS. Higher-quality studies, ideally randomized controlled trials, are needed to further quantify its benefit in this setting, and to explore multi-modal treatments that include systemic agents given concomitantly or sequentially with RT, which may offer an OS benefit in addition to the locoregional control benefit of RT. Full article
(This article belongs to the Special Issue Radiotherapy for Genitourinary Cancer)
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