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Lack of Benefit From the Addition of External Beam Radiation Therapy to Brachytherapy for Intermediate- and High-risk Prostate Cancer.

Abstract A recent randomized controlled trial demonstrated that the addition of external beam radiation therapy (EBRT) to brachytherapy did not improve progression-free survival in select patients with intermediate-risk prostate cancer. We evaluated whether the addition of EBRT to brachytherapy improves prostate cancer-specific mortality (PCSM) for intermediate- and high-risk disease using a large national database.
PMID
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Authors

Mayor MeshTerms

Brachytherapy

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




PMID- 29063853
OWN - NLM
STAT- MEDLINE
DCOM- 20171109
LR  - 20171109
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 99
IP  - 4
DP  - 2017 Nov 15
TI  - Lack of Benefit From the Addition of External Beam Radiation Therapy to
      Brachytherapy for Intermediate- and High-risk Prostate Cancer.
PG  - 904-911
LID - S0360-3016(17)33622-2 [pii]
LID - 10.1016/j.ijrobp.2017.07.034 [doi]
AB  - PURPOSE: A recent randomized controlled trial demonstrated that the addition of
      external beam radiation therapy (EBRT) to brachytherapy did not improve
      progression-free survival in select patients with intermediate-risk prostate
      cancer. We evaluated whether the addition of EBRT to brachytherapy improves
      prostate cancer-specific mortality (PCSM) for intermediate- and high-risk disease
      using a large national database. METHODS AND MATERIALS: We identified 5836
      patients in the Surveillance, Epidemiology, and End Results-Medicare linked
      database with a diagnosis of National Comprehensive Cancer Network
      intermediate-risk (Gleason score 7, prostate-specific antigen 10-20 ng/mL, or
      stage cT2b-T2c) or high-risk (Gleason score 8-10 or prostate-specific antigen >20
      ng/mL and stage </=cT3a) prostate cancer who had undergone brachytherapy, with or
      without EBRT and androgen deprivation therapy (ADT). Patients were diagnosed from
      2004 through 2009. Intermediate-risk patients with Gleason score </=3+4 and 1
      intermediate-risk factor were considered favorable and all others unfavorable. We
      used multivariable Fine-Gray competing risks regression to study PCSM while
      adjusting for sociodemographic and clinical factors and ADT use. RESULTS:
      Overall, 50.3% of intermediate- and high-risk patients who received brachytherapy
      and EBRT did not have significantly improved PCSM compared with that of the
      patients who received brachytherapy alone (adjusted hazard ratio [AHR] 1.46, 95% 
      confidence interval [CI] 0.69-3.11; P=.322; 5-year PCSM 2.4% vs 1.0%). This lack 
      of benefit was seen among favorable intermediate-risk (AHR 2.66, 95% CI
      0.93-7.62, P=.069; 5-year PCSM 1.3% vs 0.6%), unfavorable intermediate-risk (AHR 
      0.68, 95% CI 0.16-2.96, P=.612; 5-year PCSM 1.0% vs 1.2%), and high-risk (AHR
      1.82, 95% CI 0.67-4.98, P=.242; 5-year PCSM 5.3% vs 2.1%) subgroups. CONCLUSIONS:
      These results suggest that certain patients with intermediate- or high-risk
      prostate cancer treated with brachytherapy might not benefit from the addition of
      EBRT. A randomized controlled trial of brachytherapy plus ADT with or without
      EBRT for unfavorable intermediate- and favorable high-risk organ-confined
      prostate cancer should be undertaken.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Yang, David D
AU  - Yang DD
AD  - Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, 
      Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
FAU - Muralidhar, Vinayak
AU  - Muralidhar V
AD  - Harvard Medical School, Boston, Massachusetts; Harvard Radiation Oncology
      Program, Boston, Massachusetts.
FAU - Nguyen, Paul L
AU  - Nguyen PL
AD  - Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, 
      Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
FAU - Buzurovic, Ivan
AU  - Buzurovic I
AD  - Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, 
      Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
FAU - Martin, Neil E
AU  - Martin NE
AD  - Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, 
      Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
FAU - Mouw, Kent W
AU  - Mouw KW
AD  - Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, 
      Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
FAU - Devlin, Phillip M
AU  - Devlin PM
AD  - Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, 
      Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
FAU - Trinh, Quoc-Dien
AU  - Trinh QD
AD  - Harvard Medical School, Boston, Massachusetts; Division of Urological Surgery,
      Brigham and Women's Hospital, Boston, Massachusetts.
FAU - Orio, Peter F 3rd
AU  - Orio PF 3rd
AD  - Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, 
      Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
FAU - King, Martin T
AU  - King MT
AD  - Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, 
      Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
      Electronic address: [email protected]
LA  - eng
PT  - Evaluation Studies
PT  - Journal Article
DEP - 20170731
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Aged
MH  - *Brachytherapy
MH  - Combined Modality Therapy/methods
MH  - Databases, Factual
MH  - Humans
MH  - Male
MH  - Neoplasm Grading
MH  - Propensity Score
MH  - Prostatic Neoplasms/mortality/pathology/*radiotherapy
MH  - SEER Program
EDAT- 2017/10/25 06:00
MHDA- 2017/11/10 06:00
CRDT- 2017/10/25 06:00
PHST- 2017/05/19 00:00 [received]
PHST- 2017/07/11 00:00 [revised]
PHST- 2017/07/24 00:00 [accepted]
PHST- 2017/10/25 06:00 [entrez]
PHST- 2017/10/25 06:00 [pubmed]
PHST- 2017/11/10 06:00 [medline]
AID - S0360-3016(17)33622-2 [pii]
AID - 10.1016/j.ijrobp.2017.07.034 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2017 Nov 15;99(4):904-911. doi:
      10.1016/j.ijrobp.2017.07.034. Epub 2017 Jul 31.