ABSTRACT
PURPOSE
The addition of a brachytherapy (BT) boost to external beam radiotherapy (EBRT) reduces
recurrence risk in men with high-risk prostate cancer (PCa) and may reduce PCa-mortality
for Gleason grade group 5 (GG5). Whether the extent of pattern five, a risk factor
for distant metastases, impacts the benefit of a BT boost is unclear.
METHODS
Men with localized GG5 PCa treated with (
[1]
) EBRT or (
[2]
) EBRT+BT between 2010 and 2016 were identified in the National Cancer Database. EBRT
monotherapy group received conventionally fractionated (1.8−2.0 Gy per fraction) ≥74
Gy or moderately hypofractionated (2.5−3.0 Gy per fraction) ≥60 Gy. EBRT + BT group
received conventionally fractionated ≥45 Gy or moderately hypofractionated ≥37.5 Gy,
and either LDR or HDR BT. All patients received concomitant ADT; none received chemotherapy,
immunotherapy, or surgery. OS was compared using Kaplan-Meier, log-rank test, and
multivariable Cox proportional hazards in the overall cohort, followed by subgroups
based on primary versus secondary pattern 5. Propensity score- and exact-matching
was used to corroborate results.RESULTS
A total of 8260 men were eligible: EBRT alone (89%) versus EBRT + BT (11%). 5-year
OS for EBRT versus EBRT + BT was 76.3% and 85.0%, respectively (p = 0.002; multivariable adjusted HR 0.84, 95% CI 0.65−0.98; p = 0.04). These results remained consistent after propensity score and exact matching.
The OS advantage of a BT boost was more prominent in men with Gleason 4 + 5 PCa (p = 0.001) and not observed in men with Gleason 5 + 5 or 5 + 4 PCa.
CONCLUSIONS
Extent of pattern five may be useful in appropriately selecting men for EBRT+BT and
should be considered as a pre-randomization stratification variable for future clinical
trial design.
Keywords
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Article info
Publication history
Published online: January 10, 2023
Accepted:
December 7,
2022
Received in revised form:
October 18,
2022
Received:
June 28,
2022
Publication stage
In Press Corrected ProofFootnotes
Funding Acknowledgements: Dr. Sagar Patel is supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) under Award Number K12CA237806 from the Winship K12 Clinical Oncology Training Program.
Meeting Presentation: Abstract presented at the 2021 American Brachytherapy Society Annual Meeting Plenary Session (June 24, 2021; Virtual Format)
Identification
Copyright
© 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
