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Long-Term Results of a Randomized Trial Comparing Iridium Implant Plus External Beam Radiation Therapy With External Beam Radiation Therapy Alone in Node-Negative Locally Advanced Cancer of the Prostate.

Abstract To determine the impact on long-term survival from the addition of brachytherapy to external beam radiation therapy (EBRT) in patients with prostate cancer.
PMID
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Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate.

Authors

Mayor MeshTerms
Keywords
Journal Title international journal of radiation oncology, biology, physics
Publication Year Start




PMID- 28816169
OWN - NLM
STAT- MEDLINE
DA  - 20170817
DCOM- 20170821
LR  - 20170821
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 99
IP  - 1
DP  - 2017 Sep 01
TI  - Long-Term Results of a Randomized Trial Comparing Iridium Implant Plus External
      Beam Radiation Therapy With External Beam Radiation Therapy Alone in
      Node-Negative Locally Advanced Cancer of the Prostate.
PG  - 90-93
LID - S0360-3016(17)30910-0 [pii]
LID - 10.1016/j.ijrobp.2017.05.013 [doi]
AB  - PURPOSE: To determine the impact on long-term survival from the addition of
      brachytherapy to external beam radiation therapy (EBRT) in patients with prostate
      cancer. METHODS AND MATERIALS: Between 1992 and 1997, 104 men with cT2-3,
      surgically staged node-negative prostate cancer were randomized to receive either
      EBRT (40 Gy/20 fractions) with iridium implant (35 Gy/48 hours) or EBRT alone (66
      Gy/33 fractions) to the prostate. According to T stage, Gleason score, and
      prostate-specific antigen level, 60% of patients had high-risk disease.
      Substantial improvements in biochemical control at 8 years have previously been
      reported. Additional follow-up was collected on deaths and metastases. RESULTS:
      Median follow-up was 14 years. Five patients were lost to follow-up. All other
      patients have been followed a minimum of 13 years. There have been 75 deaths,
      including 21 from prostate cancer and 25 from second cancers. No patients
      developing a second cancer have died from prostate cancer. There was no
      difference in overall survival between the 2 treatment groups: 34 deaths (67%) in
      the implant arm and 41 (77%) in the EBRT arm (hazard ratio [HR] 1.00, 95%
      confidence interval [CI] 0.63-1.59). Similarly, there was no difference in
      prostate cancer-specific deaths: 9 (18%) patients in the implant arm compared
      with 12 (23%) in the EBRT arm (HR 0.79, 95% CI 0.34-1.87). There was no
      statistically significant difference in the number of patients developing
      metastatic disease: 10 (20%) in the implant arm and 15 (28%) in the EBRT arm (HR 
      0.70, 95% CI 0.32-1.57). Improvements in biochemical control were maintained (HR 
      0.53, 95% CI 0.31-0.88). CONCLUSIONS: Despite a dramatic reduction of biochemical
      recurrence rates, the addition of iridium implant to EBRT did not translate into 
      improved overall survival or prostate cancer-specific survival.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Dayes, Ian S
AU  - Dayes IS
AD  - Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
      Electronic address: [email protected]
FAU - Parpia, Sameer
AU  - Parpia S
AD  - Ontario Clinical Oncology Group, Juravinski Hospital, Hamilton, Ontario, Canada.
FAU - Gilbert, Jaclyn
AU  - Gilbert J
AD  - Department of Anaesthesia, McMaster University, Hamilton, Ontario, Canada.
FAU - Julian, Jim A
AU  - Julian JA
AD  - Ontario Clinical Oncology Group, Juravinski Hospital, Hamilton, Ontario, Canada.
FAU - Davis, Ian R
AU  - Davis IR
AD  - Department of Urology, St. Joseph's Health Centre, Hamilton, Ontario, Canada.
FAU - Levine, Mark N
AU  - Levine MN
AD  - Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Ontario
      Clinical Oncology Group, Juravinski Hospital, Hamilton, Ontario, Canada.
FAU - Sathya, Jinka
AU  - Sathya J
AD  - Department of Oncology, Memorial University, St. John's, Newfoundland, Canada.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20170517
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
RN  - 0 (Iridium Radioisotopes)
RN  - EC 3.4.21.77 (Prostate-Specific Antigen)
SB  - IM
MH  - Brachytherapy/*methods
MH  - Cause of Death
MH  - Follow-Up Studies
MH  - Humans
MH  - Iridium Radioisotopes/*therapeutic use
MH  - Male
MH  - Neoplasms, Second Primary/mortality
MH  - Prostate-Specific Antigen/blood
MH  - Prostatic Neoplasms/blood/*mortality/pathology/*radiotherapy
MH  - Survival Analysis
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2017/08/18 06:00
MHDA- 2017/08/22 06:00
CRDT- 2017/08/18 06:00
PHST- 2017/02/17 [received]
PHST- 2017/04/27 [revised]
PHST- 2017/05/09 [accepted]
AID - S0360-3016(17)30910-0 [pii]
AID - 10.1016/j.ijrobp.2017.05.013 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2017 Sep 1;99(1):90-93. doi:
      10.1016/j.ijrobp.2017.05.013. Epub 2017 May 17.