Assessing the impact of brachytherapy boost and androgen deprivation therapy on survival outcomes for patients with unfavorable intermediate-risk prostate cancer patients treated with external beam radiotherapy.

Autor:	Andruska N; Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO. Electronic address: andruska.neal@wustl.edu., Agabalogun T; Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO., Fischer-Valuck BW; Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA., Brenneman RJ; Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO., Huang Y; Biostatistics, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO., Gay HA; Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO., Michalski JM; Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO., Carmona R; Department of Radiation Oncology, Sylvester Cancer Center, University of Miami, FL., Baumann BC; Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO; Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, PA. Electronic address: brian.baumann@wustl.edu.
Jazyk:	angličtina
Zdroj:	Brachytherapy [Brachytherapy] 2022 Sep-Oct; Vol. 21 (5), pp. 617-625. Date of Electronic Publication: 2022 May 28.
DOI:	10.1016/j.brachy.2022.04.001
Abstrakt:	Background: Current recommendations regarding radiotherapy treatment for unfavorable intermediate-risk prostate cancer (UIR-PCa) include external beam radiotherapy (EBRT) ± brachytherapy boost (BT) ± androgen deprivation therapy (ADT). The ideal radiotherapy treatment approach for UIR-PCa has not been well-defined. We hypothesized that EBRT+BT±ADT is associated with improved overall survival (OS) relative to EBRT±ADT in men with UIR-PCa. Materials and Methods: The National Cancer Database (NCDB) was used to retrospectively identify 32,246 men diagnosed between 2004 and 2015 with UIR-PCa who received EBRT (n = 13,265), EBRT+ADT (n = 13,123), EBRT+BT (n = 3440), or EBRT+BT+ADT (n = 2418). OS was the primary outcome. Inverse probability of treatment weighting was used to adjust for covariable imbalances and weight-adjusted multivariable analysis using Cox regression modeling was used to compare OS hazard ratios. Results: Median follow-up was 60 months (range: 3-168 months). EBRT+ADT correlated with improved OS relative to EBRT alone on multivariable analysis (Hazard Ratio (HR): 0.92, [95% Confidence Interval: 0.87-0.98], p = 0.005). Compared to EBRT+ADT, EBRT+BT (HR: 0.77 [0.69-0.85], p = 3 × 10 -7 ) and EBRT+BT+ADT (HR: 0.75 [0.67-0.83], p = 6 × 10 -8 ) were associated with improved OS. Eight-years OS for the EBRT+ADT versus EBRT+BT+ADT was 70% and 78% (p < 0.0001), which is similar to historical clinical trials (ASCENDE-RT 9-year OS: 74% vs. 78%, p = 0.29). Relative to EBRT+BT, EBRT+BT+ADT was not associated with improved OS (HR: 0.99 [0.87-1.11], p = 0.82). Conclusions: In a large retrospective cohort, the addition of brachytherapy to EBRT correlated with improved survival in men with UIR-PCa. Men receiving EBRT+ADT+BT had improved OS relative to EBRT+ADT. The addition of ADT to EBRT, but not to EBRT+BT, correlated with improved OS. (Copyright © 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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