Survival outcomes of combined external beam radiotherapy and brachytherapy vs. brachytherapy alone for intermediate-risk prostate cancer patients using the National Cancer Data Base

The purpose was to evaluate survival outcomes between external beam radiotherapy (EBRT) plus brachytherapy and brachytherapy alone for intermediate-risk prostate cancer, using the National Cancer Data Base.

The National Cancer Data Base was queried for cN0M0 intermediate-risk patients treated from 2004 to 2006, with available data for Gleason score (GS), prostate-specific antigen (PSA), tumor stage, and receipt of radiation therapy (RT) and androgen deprivation therapy. RT comparison groups were the following: EBRT (40-50. 4 Gy) plus brachytherapy and brachytherapy alone.

A total of 10,571 patients were included: 3,148 received EBRT plus brachytherapy and 7,423 received brachytherapy alone. Median followup was 84 months (2-122 months); median age was 68 years (40-90 years). Unadjusted 5- and 7-year overall survival (OS) rates between EBRT plus brachytherapy vs. brachytherapy alone were 91. 4% vs. 90. 2% and 85. 7% vs. 82. 9%, respectively (p < 0. 001). EBRT plus brachytherapy was associated with longer OS compared with brachytherapy alone under multivariate (hazard ratio [HR], 0. 84; 95% confidence interval [CI], 0. 75-0. 93; p = 0. 001) and propensity score-matched analyses (HR, 0. 85; 95% CI, 0. 75-0. 97; p = 0. 006). Further subset analysis performed based on the Radiation Therapy Oncology Group 0232 inclusion criteria (GS 7 if PSA < 10 or GS < 7 if PSA 10-20) also demonstrated longer OS with EBRT plus brachytherapy (HR, 0. 87; 95% CI, 0. 77-0. 98; p = 0. 026).

EBRT plus brachytherapy is associated with a modest OS improvement compared with brachytherapy alone in this population-based analysis. Although this benefit appears statistically significant, the relatively small difference in OS raises the question of overall clinical benefit with combined modality RT for intermediate-risk prostate cancer, given the potential increased risk for toxicities. Future results from Radiation Therapy Oncology Group 0232 should provide further insight on this topic.

Brachytherapy. 2016 Jan 26 [Epub ahead of print]

Arya Amini, Bernard L Jones, Matthew W Jackson, Chad G Rusthoven, Paul Maroni, Brian D Kavanagh, David Raben

Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO. Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO. , Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO. , Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO. , Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO. , Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO. , Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO.

PubMed

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe