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Association of Brachytherapy Boost with Overall Survival for Gleason 9-10 Prostate Cancer: The Impact of Primary versus Secondary Pattern 5.
Patel, Sagar A; Baumann, Brian; Michalski, Jeff; Brenneman, Randall; Zheng, Bill; Gay, Hiram; Ferraro, Daniel; Brown, Simon A; Chang, Albert J; Rossi, Peter J; Fischer-Valuck, Benjamin W.
Afiliação
  • Patel SA; Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA. Electronic address: sagar.patel@emory.edu.
  • Baumann B; Department of Radiation Oncology, Washington University, St. Louis, MO.
  • Michalski J; Department of Radiation Oncology, Washington University, St. Louis, MO.
  • Brenneman R; Department of Radiation Oncology, Washington University, St. Louis, MO.
  • Zheng B; Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
  • Gay H; Department of Radiation Oncology, Washington University, St. Louis, MO.
  • Ferraro D; Springfield Clinic, Springfield, IL.
  • Brown SA; Springfield Clinic, Springfield, IL.
  • Chang AJ; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
  • Rossi PJ; Calaway Young Cancer Center, Valley View Hospital, Glenwood Springs, CO.
  • Fischer-Valuck BW; Springfield Clinic, Springfield, IL.
Brachytherapy ; 22(3): 310-316, 2023.
Article em En | MEDLINE | ID: mdl-36635202
PURPOSE: The addition of a brachytherapy (BT) boost to external beam radiotherapy (EBRT) reduces recurrence risk in men with high-risk prostate cancer (PCa) and may reduce PCa-mortality for Gleason grade group 5 (GG5). Whether the extent of pattern five, a risk factor for distant metastases, impacts the benefit of a BT boost is unclear. METHODS: Men with localized GG5 PCa treated with (1) EBRT or (2) EBRT+BT between 2010 and 2016 were identified in the National Cancer Database. EBRT monotherapy group received conventionally fractionated (1.8-2.0 Gy per fraction) ≥74 Gy or moderately hypofractionated (2.5-3.0 Gy per fraction) ≥60 Gy. EBRT + BT group received conventionally fractionated ≥45 Gy or moderately hypofractionated ≥37.5 Gy, and either LDR or HDR BT. All patients received concomitant ADT; none received chemotherapy, immunotherapy, or surgery. OS was compared using Kaplan-Meier, log-rank test, and multivariable Cox proportional hazards in the overall cohort, followed by subgroups based on primary versus secondary pattern 5. Propensity score- and exact-matching was used to corroborate results. RESULTS: A total of 8260 men were eligible: EBRT alone (89%) versus EBRT + BT (11%). 5-year OS for EBRT versus EBRT + BT was 76.3% and 85.0%, respectively (p = 0.002; multivariable adjusted HR 0.84, 95% CI 0.65-0.98; p = 0.04). These results remained consistent after propensity score and exact matching. The OS advantage of a BT boost was more prominent in men with Gleason 4 + 5 PCa (p = 0.001) and not observed in men with Gleason 5 + 5 or 5 + 4 PCa. CONCLUSIONS: Extent of pattern five may be useful in appropriately selecting men for EBRT+BT and should be considered as a pre-randomization stratification variable for future clinical trial design.
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Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Neoplasias da Próstata / Braquiterapia Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans / Male Idioma: En Revista: Brachytherapy Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Neoplasias da Próstata / Braquiterapia Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans / Male Idioma: En Revista: Brachytherapy Ano de publicação: 2023 Tipo de documento: Article