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Prostate-only Versus Whole-pelvis Radiation with or Without a Brachytherapy Boost for Gleason Grade Group 5 Prostate Cancer: A Retrospective Analysis.
Sandler, Kiri A; Cook, Ryan R; Ciezki, Jay P; Ross, Ashley E; Pomerantz, Mark M; Nguyen, Paul L; Shaikh, Talha; Tran, Phuoc T; Stock, Richard G; Merrick, Gregory S; Demanes, David Jeffrey; Spratt, Daniel E; Abu-Isa, Eyad I; Wedde, Trude B; Lilleby, Wolfgang; Krauss, Daniel J; Shaw, Grace K; Alam, Ridwan; Reddy, Chandana A; Song, Daniel Y; Klein, Eric A; Stephenson, Andrew J; Tosoian, Jeffrey J; Hegde, John V; Yoo, Sun Mi; Fiano, Ryan; D'Amico, Anthony V; Nickols, Nicholas G; Aronson, William J; Sadeghi, Ahmad; Greco, Stephen C; Deville, Curtiland; McNutt, Todd; DeWeese, Theodore L; Reiter, Robert E; Said, Jonathan W; Steinberg, Michael L; Horwitz, Eric M; Kupelian, Patrick A; King, Christopher R; Kishan, Amar U.
Afiliação
  • 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; 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.
Eur Urol ; 77(1): 3-10, 2020 01.
Article em En | MEDLINE | ID: mdl-30992160
ABSTRACT

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.
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Texto completo: 1 Coleções: 01-internacional Temas: Geral / Prevencao_e_fatores_de_risco / Agentes_cancerigenos / Tipos_de_cancer / Prostata / Tratamento / Radioterapia Base de dados: MEDLINE Assunto principal: Neoplasias da Próstata / Braquiterapia / Irradiação Hemicorpórea Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Humans / Male Idioma: En Revista: Eur Urol Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Estados Unidos
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Temas: Geral / Prevencao_e_fatores_de_risco / Agentes_cancerigenos / Tipos_de_cancer / Prostata / Tratamento / Radioterapia Base de dados: MEDLINE Assunto principal: Neoplasias da Próstata / Braquiterapia / Irradiação Hemicorpórea Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Humans / Male Idioma: En Revista: Eur Urol Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Estados Unidos