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Lack of Apparent Survival Benefit With Use of Androgen Deprivation Therapy in Patients With High-risk Prostate Cancer Receiving Combined External Beam Radiation Therapy and Brachytherapy.

Abstract Although level 1 evidence has demonstrated a survival benefit from the addition of androgen deprivation therapy (ADT) to external beam radiation therapy (EBRT) for patients with high-risk prostate cancer, the benefits of ADT with combined EBRT and brachytherapy for high-risk patients are unclear. We examined the association between ADT and overall survival in a national cohort of high-risk patients treated with EBRT with or without brachytherapy.
PMID
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Authors

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




PMID- 29254781
OWN - NLM
STAT- MEDLINE
DCOM- 20180104
LR  - 20180104
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 100
IP  - 1
DP  - 2018 Jan 1
TI  - Lack of Apparent Survival Benefit With Use of Androgen Deprivation Therapy in
      Patients With High-risk Prostate Cancer Receiving Combined External Beam
      Radiation Therapy and Brachytherapy.
PG  - 53-58
LID - S0360-3016(17)33843-9 [pii]
LID - 10.1016/j.ijrobp.2017.08.046 [doi]
AB  - PURPOSE: Although level 1 evidence has demonstrated a survival benefit from the
      addition of androgen deprivation therapy (ADT) to external beam radiation therapy
      (EBRT) for patients with high-risk prostate cancer, the benefits of ADT with
      combined EBRT and brachytherapy for high-risk patients are unclear. We examined
      the association between ADT and overall survival in a national cohort of
      high-risk patients treated with EBRT with or without brachytherapy. METHODS AND
      MATERIALS: We identified 46,325 men in the National Cancer Database with a
      diagnosis of high-risk prostate cancer (Gleason score 8-10, clinical stage T3-T4,
      or prostate-specific antigen >20 ng/mL) who were treated with EBRT with or
      without brachytherapy and ADT from 2004 through 2011. Multivariable Cox
      regression analysis adjusting for sociodemographic and clinicopathologic factors 
      was used to identify the association between ADT and overall survival. RESULTS:
      The median follow-up period was 48.6 and 59.2 months for patients treated with
      EBRT only and combined modality RT, respectively. ADT was associated with an
      improvement in overall survival for the 85.0% (39,361) of the study cohort who
      underwent EBRT alone (adjusted hazard ratio 0.91, P=.001) but not for patients
      treated with combined modality RT (adjusted hazard ratio 1.05, P=.496), with a
      significant interaction (Pinteraction=.036). CONCLUSIONS: In contrast to the
      known survival benefit when ADT is given with EBRT, our results suggest that ADT 
      might not improve survival for high-risk patients who undergo combined EBRT and
      brachytherapy. Given the significant adverse effects of ADT, in particular, with 
      long-term therapy, a randomized controlled trial of combined EBRT and
      brachytherapy with or without ADT for select high-risk patients using a
      noninferiority design 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.
FAU - Muralidhar, Vinayak
AU  - Muralidhar V
AD  - Harvard Radiation Oncology Program, Boston, Massachusetts.
FAU - Mahal, Brandon A
AU  - Mahal BA
AD  - 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 - 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 - 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.
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.
      Electronic address: [email protected]
LA  - eng
PT  - Journal Article
DEP - 20170909
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
RN  - 0 (Androgen Antagonists)
RN  - EC 3.4.21.77 (Prostate-Specific Antigen)
SB  - IM
MH  - Aged
MH  - Androgen Antagonists/*adverse effects
MH  - Brachytherapy/*mortality
MH  - Combined Modality Therapy/methods/mortality
MH  - Databases, Factual/statistics & numerical data
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Grading
MH  - Neoplasm Staging
MH  - Prostate-Specific Antigen/blood
MH  - Prostatic Neoplasms/drug therapy/*mortality/pathology/*radiotherapy
EDAT- 2017/12/20 06:00
MHDA- 2018/01/05 06:00
CRDT- 2017/12/20 06:00
PHST- 2017/06/14 00:00 [received]
PHST- 2017/08/12 00:00 [revised]
PHST- 2017/08/30 00:00 [accepted]
PHST- 2017/12/20 06:00 [entrez]
PHST- 2017/12/20 06:00 [pubmed]
PHST- 2018/01/05 06:00 [medline]
AID - S0360-3016(17)33843-9 [pii]
AID - 10.1016/j.ijrobp.2017.08.046 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2018 Jan 1;100(1):53-58. doi:
      10.1016/j.ijrobp.2017.08.046. Epub 2017 Sep 9.