Prostate-only Versus Whole-pelvis Radiation with or Without a Brachytherapy Boost for Gleason Grade Group 5 Prostate Cancer: A Retrospective Analysis.

Autor:	Sandler KA; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA., Cook RR; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA., Ciezki JP; Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA., Ross AE; Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Pomerantz MM; Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA., Nguyen PL; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA., Shaikh T; Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA., Tran PT; Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Stock RG; Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York City, NY, USA., Merrick GS; Schiffler Cancer Center, Wheeling Hospital, Wheeling Jesuit University, Wheeling, WV, USA., Demanes DJ; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA., Spratt DE; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA., Abu-Isa EI; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA., Wedde TB; Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway., Lilleby W; Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway., Krauss DJ; Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA., Shaw GK; Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA., Alam R; Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Reddy CA; Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Song DY; Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Klein EA; Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA., Stephenson AJ; Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA., Tosoian JJ; Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Hegde JV; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA., Yoo SM; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA., Fiano R; Schiffler Cancer Center, Wheeling Hospital, Wheeling Jesuit University, Wheeling, WV, USA., D'Amico AV; Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA., Nickols NG; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Radiation Oncology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA., Aronson WJ; Department of Radiation Oncology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA., Sadeghi A; Department of Radiation Oncology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA., Greco SC; Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Deville C Jr; Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., McNutt T; Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., DeWeese TL; Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA., Reiter RE; Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA., Said JW; Department of Pathology, University of California, Los Angeles, Los Angeles, CA, USA., Steinberg ML; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA., Horwitz EM; Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA., Kupelian PA; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA., King CR; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA., Kishan AU; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA. Electronic address: aukishan@mednet.ucla.edu.
Jazyk:	angličtina
Zdroj:	European urology [Eur Urol] 2020 Jan; Vol. 77 (1), pp. 3-10. Date of Electronic Publication: 2019 Apr 13.
DOI:	10.1016/j.eururo.2019.03.022
Abstrakt:	Background: The role of elective whole-pelvis radiotherapy (WPRT) remains controversial. Few studies have investigated it in Gleason grade group (GG) 5 prostate cancer (PCa), known to have a high risk of nodal metastases. Objective: To assess the impact of WPRT on patients with GG 5 PCa treated with external-beam radiotherapy (EBRT) or EBRT with a brachytherapy boost (EBRT+BT). Design, Setting, and Participants: We identified 1170 patients with biopsy-proven GG 5 PCa from 11 centers in the United States and one in Norway treated between 2000 and 2013 (734 with EBRT and 436 with EBRT+BT). Outcome Measurements and Statistical Analysis: Biochemical recurrence-free survival (bRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific survival (PCSS) were compared using Cox proportional hazards models with propensity score adjustment. Results and Limitations: A total of 299 EBRT patients (41%) and 320 EBRT+BT patients (73%) received WPRT. The adjusted 5-yr bRFS rates with WPRT in the EBRT and EBRT+BT groups were 66% and 88%, respectively. Without WPRT, these rates for the EBRT and EBRT+BT groups were 58% and 78%, respectively. The median follow-up was 5.6yr. WPRT was associated with improved bRFS among patients treated with EBRT+BT (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.2-0.9, p=0.02), but no evidence for improvement was found in those treated with EBRT (HR 0.8, 95% CI 0.6-1.2, p=0.4). WPRT was not significantly associated with improved DMFS or PCSS in the EBRT group (HR 1.1, 95% CI 0.7-1.7, p=0.8 for DMFS and HR 0.7, 95% CI 0.4-1.1, p=0.1 for PCSS), or in the EBRT+BT group (HR 0.6, 95% CI 0.3-1.4, p=0.2 for DMFS and HR 0.5 95% CI 0.2-1.2, p=0.1 for PCSS). Conclusions: WPRT was not associated with improved PCSS or DMFS in patients with GG 5 PCa who received either EBRT or EBRT+BT. However, WPRT was associated with a significant improvement in bRFS among patients receiving EBRT+BT. Strategies to optimize WPRT, potentially with the use of advanced imaging techniques to identify occult nodal disease, are warranted. Patient Summary: When men with a high Gleason grade prostate cancer receive radiation with external radiation and brachytherapy, the addition of radiation to the pelvis results in a longer duration of prostate-specific antigen control. However, we did not find a difference in their survival from prostate cancer or in their survival without metastatic disease. We also did not find a benefit for radiation to the pelvis in men who received radiation without brachytherapy. (Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Databáze:	MEDLINE
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