Survival outcomes of combined external beam radiotherapy and brachytherapy vs. brachytherapy alone for intermediate-risk prostate cancer patients using the National Cancer Data Base
| Autor: | Paul Maroni, Matthew W. Jackson, Chad G. Rusthoven, Bernard L. Jones, Brian D. Kavanagh, Arya Amini, David Raben |
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| Rok vydání: | 2015 |
| Předmět: |
Oncology
Adult Male medicine.medical_specialty Databases Factual medicine.medical_treatment Brachytherapy Population Urology 030218 nuclear medicine & medical imaging Androgen deprivation therapy 03 medical and health sciences Prostate cancer 0302 clinical medicine Internal medicine medicine Humans Radiology Nuclear Medicine and imaging External beam radiotherapy education Propensity Score Survival rate Aged Proportional Hazards Models Aged 80 and over education.field_of_study business.industry Prostatic Neoplasms Androgen Antagonists Middle Aged Prostate-Specific Antigen medicine.disease Combined Modality Therapy United States Radiation therapy Survival Rate Prostate-specific antigen 030220 oncology & carcinogenesis Neoplasm Grading business Follow-Up Studies |
| Zdroj: | Brachytherapy. 15(2) |
| ISSN: | 1873-1449 |
| Popis: | PURPOSE: The purpose was to evaluate survival outcomes between external beam radiotherapy (EBRT) plus brachytherapy and brachytherapy alone for intermediate-risk prostate cancer, using the National Cancer Data Base. METHODS AND MATERIALS: The National Cancer Data Base was queried for cN0M0 intermediate-risk patients treated from 2004 to 2006, with available data for Gleason score (GS), prostate-specific antigen (PSA), tumor stage, and receipt of radiation therapy (RT) and androgen deprivation therapy. RT comparison groups were the following: EBRT (40e50.4 Gy) plus brachy- therapy and brachytherapy alone. RESULTS: A total of 10,571 patients were included: 3,148 received EBRT plus brachytherapy and 7,423 received brachytherapy alone. Median followup was 84 months (2e122 months); median age was 68 years (40e90 years). Unadjusted 5- and 7-year overall survival (OS) rates between EBRT plus brachytherapy vs. brachytherapy alone were 91.4% vs. 90.2% and 85.7% vs. 82.9%, respec- tively (p ! 0.001). EBRT plus brachytherapy was associated with longer OS compared with brachytherapy alone under multivariate (hazard ratio (HR), 0.84; 95% confidence interval (CI), 0.75e0.93; p 5 0.001) and propensity score-matched analyses (HR, 0.85; 95% CI, 0.75e0.97; p 5 0.006). Further subset analysis performed based on the Radiation Therapy Oncology Group 0232 inclusion criteria (GS 7 if PSA ! 10 or GS ! 7 if PSA 10e20) also demonstrated longer OS with EBRT plus brachytherapy (HR, 0.87; 95% CI, 0.77e0.98; p 5 0.026). CONCLUSIONS: EBRT plus brachytherapy is associated with a modest OS improvement compared with brachytherapy alone in this population-based analysis. Although this benefit appears statistically significant, the relatively small difference in OS raises the question of overall clinical benefit with combined modality RT for intermediate-risk prostate cancer, given the potential increased risk for toxicities. Future results from Radiation Therapy Oncology Group 0232 should provide further insight on this topic. 2016 American Brachytherapy Society. Published by Elsev- ier Inc. All rights reserved. |
| Databáze: | OpenAIRE |
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