Survival Outcomes of Whole-Pelvic Versus Prostate-Only Radiation Therapy for High-Risk Prostate Cancer Patients With Use of the National Cancer Data Base.

PURPOSE/OBJECTIVES - The addition of whole pelvic (WP) compared with prostate-only (PO) radiation therapy (RT) for clinically node-negative prostate cancer remains controversial. The purpose of our study was to evaluate the survival benefit of adding WPRT versus PO-RT for high-risk, node-negative prostate cancer, using the National Cancer Data Base (NCDB).

METHODS AND MATERIALS - Patients with high-risk prostate cancer treated from 2004 to 2006, with available data for RT volume, coded as prostate and pelvis (WPRT) or prostate alone (PO-RT) were included. Multivariate analysis (MVA) and propensity-score matched analysis (PSM) were performed. Recursive partitioning analysis (RPA) based on overall survival (OS) using Gleason score (GS), T stage, and pretreatment prostate-specific antigen (PSA) was also conducted.

RESULTS - A total of 14,817 patients were included: 7606 (51. 3%) received WPRT, and 7211 (48. 7%) received PO-RT. The median follow-up time was 81 months (range, 2-122 months). Under MVA, the addition of WPRT for high-risk patients had no OS benefit compared with PO-RT (HR 1. 05; P=. 100). On subset analysis, patients receiving dose-escalated RT also did not benefit from WPRT (HR 1. 01; P=. 908). PSM confirmed no survival benefit with the addition of WPRT for high-risk patients (HR 1. 05; P=. 141). In addition, RPA was unable to demonstrate a survival benefit of WPRT for any subset. Other prognostic factors for inferior OS under MVA included older age (HR 1. 25; P

CONCLUSION - In the largest reported analysis of WPRT for patients with high-risk prostate cancer treated in the dose-escalated era, the addition of WPRT demonstrated no survival advantage compared with PO-RT.

International journal of radiation oncology, biology, physics. 2015 Sep 18 [Epub]

Arya Amini, Bernard L Jones, Norman Yeh, Chad G Rusthoven, Hirotatsu Armstrong, Brian D Kavanagh

Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. , Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. , Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. , Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. , Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. , Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. 

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