Abstract
Purpose
Androgen suppression combined with elective nodal and dose-escalated radiation therapy
recently demonstrated an improved biochemical failure–free survival in men who received
external beam radiation therapy (EBRT) plus a brachytherapy boost (BB) compared with
dose-escalated external beam radiotherapy (DE-EBRT). We sought to analyze the factors
predictive for use of EBRT + BB as compared with DE-EBRT and report resulting survival
outcomes on a national level using a hospital-based registry.
Methods and Materials
We identified 113,719 men from the National Cancer Database from 2004 to 2013 with
intermediate- or high-risk prostate cancer who were treated with EBRT + BB or DE-EBRT.
We performed univariate and multivariate analyses of all available factors potentially
predictive of receipt of treatment selection. Survival was evaluated in a multivariable
model with propensity adjustment.
Results
For intermediate-risk patients, utilization of BB decreased from 33.1% (n = 1742) in 2004 to 12.5% (n = 766) in 2013 and for high-risk patients, utilization dropped from 27.6% (n = 879) to 10.8% (n = 479). Numerous factors predictive for use of BB were identified. Cox proportional
hazards analysis was performed—adjusting for age, Charlson–Deyo comorbidity score,
T stage, prostate-specific antigen, Gleason score, and sociodemographic factors—and
demonstrated BB use was associated with a hazard ratio of 0.71 (95% confidence interval,
0.67–0.75; p < 0.0005) and 0.73 (95% confidence interval, 0.68–0.78; p < 0.0005) for intermediate- and high-risk patients, respectively.
Conclusions
There has been a concerning decline in the utilization of BB for intermediate- and
high-risk prostate cancer patients despite an association with improved on overall
survival. Numerous factors predictive for use of BB have been identified.
Keywords
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References
- Cancer treatment and survivorship statistics, 2016.CA Cancer J Clin. 2016; 66: 271-289
- Use of additional treatment for prostate cancer after radical prostatectomy, radiation therapy, androgen deprivation, or watchful waiting.Scand J Urol Nephrol. 2007; 41: 198-203
- Comparative analysis of prostate-specific antigen free survival outcomes for patients with low, intermediate and high risk prostate cancer treatment by radical therapy. Results from the Prostate Cancer Results Study Group.BJU Int. 2012; 109: 22-29
- Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer.Int J Radiat Oncol Biol Phys. 2008; 70: 67-74
- Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: First results from the MRC RT01 randomised controlled trial.Lancet Oncol. 2007; 8: 475-487
- Update of Dutch multicenter dose-escalation trial of radiotherapy for localized prostate cancer.Int J Radiat Oncol Biol Phys. 2008; 72: 980-988
- Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: Long-term results from Proton Radiation Oncology Group/American College of Radiology 95-09.J Clin Oncol. 2010; 28: 1106-1111
- Phase II trial of combined high-dose-rate brachytherapy and external beam radiotherapy for adenocarcinoma of the prostate: Preliminary results of RTOG 0321.Int J Radiat Oncol Biol Phys. 2010; 78: 751-758
- Hypofractionated boost with high-dose-rate brachytherapy and open magnetic resonance imaging-guided implants for locally aggressive prostate cancer: A sequential dose-escalation pilot study.Int J Radiat Oncol Biol Phys. 2009; 75: 656-663
- Hypofractionated conformal HDR brachytherapy in hormone naïve men with localized prostate cancer. Is escalation to very high biologically equivalent dose beneficial in all prognostic risk groups?.Strahlenther Onkol. 2006; 182: 135-141
- Dose escalation using conformal high-dose-rate brachytherapy improves outcome in unfavorable prostate cancer.Int J Radiat Oncol Biol Phys. 2002; 53: 316-327
- Morbidity and prostate-specific antigen control of external beam radiation therapy plus low-dose-rate brachytherapy boost for low, intermediate, and high-risk prostate cancer.Brachytherapy. 2009; 8: 191-196
- ASCENDE-RT*: A multicenter, randomized trial of dose-escalated external beam radiation therapy (EBRT-B) versus low-dose-rate brachytherapy (LDR-B) for men with unfavorable-risk localized prostate cancer.J Clin Oncol. 2015; 33 (abstr 3)
- Comparison of commission on cancer-approved and -nonapproved hospitals in the United States: Implications for studies that use the National Cancer Data Base.J Clin Oncol. 2009; 27: 4177-4181
- The National Cancer Data Base: A powerful initiative to improve cancer care in the United States.Ann Surg Oncol. 2008; 15: 683-690
- NCCN clinical practice guidelines in oncology: prostate cancer. Version 3. NCCN.org, 2016
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation.J Chronic Dis. 1987; 40: 373-383
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.J Clin Epidemiol. 1992; 45: 613-619
- Propensity score.in: Encyclopedia of biostatistics. 2nd ed. Wiley, Chichester, England2005: 4267-4272
- Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group.Stat Med. 1998; 17: 2265-2281
- Goodness-of-fit diagnostics for the propensity score model when estimating treatment effects using covariate adjustment with the propensity score.Pharmacoepidemiol Drug Saf. 2008; 17: 1202-1217
- An empirical comparison of tree-based methods for propensity score estimation.Health Serv Res. 2013; 48: 1798-1817
- Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: A matched analysis using propensity scores.J Clin Epidemiol. 2001; 54: 387-398
- The comparison of stereotactic body radiation therapy and intensity-modulated radiation therapy for prostate cancer by NCCN risk groups.Front Oncol. 2016; 6: 184
- Risk-based management of prostate cancer.N Engl J Med. 2011; 365: 169-171
- Multicenter analysis of effect of high biologic effective dose on biochemical failure and survival outcomes in patients with Gleason score 7-10 prostate cancer treated with permanent prostate brachytherapy.Int J Radiat Oncol Biol Phys. 2009; 73: 341-346
- Combined modality treatment in the management of high-risk prostate cancer.Int J Radiat Oncol Biol Phys. 2004; 59: 1352-1359
- High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer.J Urol. 2001; 166: 876-881
- Patterns of local failure following prostate brachytherapy.J Urol. 2007; 177 (discussion 1764): 1759-1763
- Intermediate term biochemical-free progression and local control following 125iodine brachytherapy for prostate cancer.J Urol. 2005; 173: 803-807
- Combined treatment with temporary short-term high dose rate iridium-192 brachytherapy and external beam radiotherapy for irradiation of localized prostatic carcinoma.Radiother Oncol. 1997; 44: 237-244
- Combination therapy improves prostate cancer survival for patients with potentially lethal prostate cancer: The impact of Gleason pattern 5.Brachytherapy. 2015; 14: 502-510
- Clinical outcomes for patients with Gleason score 9–10 prostate adenocarcinoma treated with radiotherapy or radical prostatectomy: A multi-institutional comparative analysis.Eur Urol. 2016; (http://dx.doi.org/10.1016/j.eururo.2016.06.046 [Epub ahead of print])
- Survival outcomes of combined external beam radiotherapy and brachytherapy vs. brachytherapy alone for intermediate-risk prostate cancer patients using the National Cancer Data Base.Brachytherapy. 2016; 15: 136-146
- Survival outcomes of dose-escalated external beam radiotherapy versus combined brachytherapy for intermediate and high risk prostate cancer using the National Cancer Data Base.J Urol. 2016; 195: 1453-1458
- The rise and fall of prostate brachytherapy: Use of brachytherapy for the treatment of localized prostate cancer in the National Cancer Data Base.Cancer. 2014; 120: 2114-2121
- Prostate brachytherapy case volumes by academic and nonacademic practices: Implications for future residency training.Int J Radiat Oncol. 2016; 96: 624-628
- The decreased use of brachytherapy boost for intermediate and high-risk prostate cancer despite evidence supporting its effectiveness.Brachytherapy. 2016; 15: 701-706
- Declining use of brachytherapy for the treatment of prostate cancer.Brachytherapy. 2014; 13: 157-162
- National Cancer Data Base analysis of radiation therapy consolidation modality for cervical cancer: The impact of new technological advancements.Int J Radiat Oncol Biol Phys. 2014; 90: 1083-1090
- Interim report of image-guided conformal high-dose-rate brachytherapy for patients with unfavorable prostate cancer: The William Beaumont phase II dose-escalating trial.Int J Radiat Oncol Biol Phys. 2000; 47: 343-352
- High dose rate brachytherapy in combination with external beam radiotherapy in the radical treatment of prostate cancer: Initial results of a randomised phase three trial.Radiother Oncol. 2007; 84: 114-120
- Fractionated perineal high-dose-rate temporary brachytherapy combined with external beam radiation in the treatment of localized prostate cancer: Is lymph node sampling necessary?.Cancer Radiother. 2003; 7: 100-106
- 3D conformal HDR brachytherapy and external beam irradiation combined with temporary androgen deprivation in the treatment of localized prostate cancer.Radiother Oncol. 2004; 71: 35-41
- Clinical results of combined treatment conformal high-dose-rate iridium-192 brachytherapy and external beam radiotherapy using staging lymphadenectomy for localized prostate cancer.Int J Radiat Oncol Biol Phys. 2004; 59: 684-690
Article info
Publication history
Published online: February 01, 2017
Accepted:
December 22,
2016
Received in revised form:
December 12,
2016
Received:
November 5,
2016
Footnotes
Declaration: Data were presented in abstract format at the American Brachytherapy Society Annual Meeting/World Congress, San Francisco, 2016.
The data used in the present study were derived from a deidentified National Cancer Data Base file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology used or the conclusions drawn from these data by the investigators. The interpretation and reporting of these data are the sole responsibility of the authors.
Financial disclosure/conflicts of interest: Acute or potential conflict of interest does not exist. The authors do not have anything to disclose.
Identification
Copyright
© 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
