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.
Brachytherapy
; 21(5): 617-625, 2022.
Article
en En
| MEDLINE
| ID: mdl-35641370
ABSTRACT
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 ANDMETHODS:
The National Cancer Database (NCDB) was used to retrospectively identify 32,246 men diagnosed between 2004 and 2015 with UIR-PCa who received EBRT (nâ¯=â¯13,265), EBRT+ADT (nâ¯=â¯13,123), EBRT+BT (nâ¯=â¯3440), or EBRT+BT+ADT (nâ¯=â¯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], pâ¯=â¯0.005). Compared to EBRT+ADT, EBRT+BT (HR 0.77 [0.69-0.85], pâ¯=â¯3â¯×â¯10-7) and EBRT+BT+ADT (HR 0.75 [0.67-0.83], pâ¯=â¯6â¯×â¯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%, pâ¯=â¯0.29). Relative to EBRT+BT, EBRT+BT+ADT was not associated with improved OS (HR 0.99 [0.87-1.11], pâ¯=â¯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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias de la Próstata
/
Braquiterapia
Tipo de estudio:
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Humans
/
Male
Idioma:
En
Revista:
Brachytherapy
Asunto de la revista:
RADIOTERAPIA
Año:
2022
Tipo del documento:
Article