Impact of dose-escalated radiation on overall survival in men with nonmetastatic prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 28-28
Author(s):  
Anusha Kalbasi ◽  
Jiaqi Li ◽  
Abigail T. Berman ◽  
Samuel Swisher-McClure ◽  
Marc C. Smaldone ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
High Risk ◽  
Standard Dose ◽  
Low Risk ◽  
External Beam Radiation ◽  
Risk Category ◽  
Beam Radiation ◽  
Treatment Groups

28 Background: Infive publishedRCTs, dose-escalated external beam radiation therapy (EBRT) for prostate cancer resulted in improved biochemical and local control. However, the question of whether dose escalation improves overall survival (OS) remains unanswered. We examined OS among men with non-metastatic prostate cancer undergoing EBRT in the modern era. Methods: Using the National Cancer Database (NCDB), we conducted non-randomized comparative effectiveness studies of dose-escalated versus standard-dose EBRT in men diagnosed from 2004-2006 in three analytic cohorts defined by NCCN risk category: low- (N=12,848), intermediate- (N=14,966) or high-risk (N=14,587) prostate cancer. We categorized patients in each risk cohort into 2 treatment groups: standard-dose (68.4 Gy to <75.6 Gy) or dose-escalated (≥75.6 Gy to 90 Gy) EBRT. The primary outcome was time to death from any cause, measured from diagnosis to NCDB date of death or end of follow-up (December 31, 2011). We compared OS between treatment groups in the three analytic cohorts using Cox proportional hazard models. Inverse probability weighted propensity score methods were used to balance differences between treatment groups in age, race, year of diagnosis, AJCC T- and N-stage, PSA, Gleason score, androgen deprivation therapy, IMRT use, comorbid disease, income, insurance, urban/rural location, facility type and facility volume. In secondary analyses, we evaluated dose response for survival by categorizing dose in approximately 2 Gy increments. Results: Median follow up for survivors was between 73 and 74 months in all three risk cohorts. Dose-escalated EBRT was associated with improved survival in the intermediate-risk (adjusted HR 0.81, 95% CI 0.77 and 0.85, p<0.0001) and high-risk groups (aHR 0.85, 95% CI 0.81 and 0.89, p<0.0001), but not the low-risk group (aHR 0.99, 95% CI 0.92-1.06, p=0.803). For every incremental ~2Gy increase in dose, there was a 9% (95% CI 6% – 11%, p<0.0001) and 7% (95% CI 3% - 10%, p=0.004) reduction in the hazard of death for intermediate- and high-risk patients, respectively. Conclusions: Dose-escalated EBRT is associated with improved survival in men with intermediate- and high-risk, but not low-risk, prostate cancer.

scholarly journals Trimodal therapy with high-dose-rate brachytherapy and hypofractionated external beam radiation combined with long-term androgen deprivation for unfavorable-risk prostate cancer

2021 ◽  
Author(s):  
Keiichiro Mori ◽  
Hiroshi Sasaki ◽  
Yuki Tsutsumi ◽  
Shun Sato ◽  
Yuki Takiguchi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
High Dose Rate ◽  
External Beam Radiation ◽  
High Dose ◽  
External Beam ◽  
Beam Radiation ◽  
Trimodal Therapy

Abstract Purpose To assess the outcomes of high-dose-rate (HDR) brachytherapy and hypofractionated external beam radiation therapy (EBRT) combined with long-term androgen deprivation therapy (ADT) in very-high-risk (VHR) versus high-risk (HR) prostate cancer (PCa), as defined in the National Comprehensive Cancer Network (NCCN) criteria. Methods Data from 338 consecutive HR or VHR PCa patients who had undergone this tri-modal therapy between 2005 and 2018 were retrospectively analyzed. Biochemical recurrence (BCR)-free, progression-free, overall, and cancer-specific survival (BCRFS/PFS/OS/CSS) rates were analyzed using the Kaplan–Meier method and Wilcoxon test. Cox regression models were used to evaluate candidate prognostic factors for survival. C‑indexes were used to assess model discrimination. Results Within a median follow-up of 84 months, 68 patients experienced BCR, 58 had disease progression including only 3 with local progression, 27 died of any cause, and 2 died from PCa. The 5‑year BCRFS, PFS, OS, and CSS rates were 82.2% (HR 86.5%; VHR 70.0%), 90.0% (HR 94.3%; VHR 77.6%), 95.7% (HR, 97.1%; VHR, 91.8%), and 99.6% (HR, 100%; VHR, 98.0%), respectively. In multivariable analyses that adjusted for standard clinicopathologic features, the risk subclassification was associated both PFS and OS (p = 0.0003 and 0.001, respectively). Adding the risk subclassification improved the accuracy of models in predicting BCRFS, PFS, and OS. Conclusion While the outcome of this trimodal approach appears favorable, VHR PCa patients had significantly worse oncological outcomes than those with HR PCa. The NCCN risk subclassification should be integrated into prognostic tools to guide risk stratification, treatment, and follow-up for unfavorable PCa patients receiving this trimodal therapy.

Comparison of Neoadjuvant vs Concurrent/Adjuvant Androgen Deprivation in Men with High-risk Prostate Cancer Receiving Definitive Radiation Therapy

2017 ◽  
Vol 103 (4) ◽  
pp. 387-393
Author(s):  
Anna Lee ◽  
Daniel J. Becker ◽  
Ariel J. Lederman ◽  
Virginia W. Osborn ◽  
Meng S. Shao ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
High Risk ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

Purpose It is unknown whether there is a benefit to starting androgen deprivation therapy (ADT) prior to rather than concurrently with definitive radiation therapy in men with high-risk prostate cancer. We studied the National Cancer Data Base to determine whether the timing of ADT impacts survival. Methods Men diagnosed with high-risk prostate adenocarcinoma who received external beam radiation therapy (EBRT) to a dose of 70-81 Gy along with ADT from 2004-2011 were included. Those who started ADT 42-90 days before EBRT were identified as having received neoadjuvant hormonal therapy (N-HT) and those who received ADT from 14 days before their radiation until 84 days after the start of EBRT were categorized as receiving concurrent/adjuvant treatment (C-HT). We used the log-rank test to compare Kaplan-Meier survival curves and multivariable Cox regression to assess the impact of covariables on overall survival (OS). Results Among 11,491 included patients, those receiving N-HT were 1 year older ( p<0.001) and more likely to have Gleason 8-10 disease ( p = 0.01) and cT3-4 disease ( p = 0.002). Men receiving N-HT had a 5-year and median OS of 80.6% and 111.4 months, respectively, compared to 78.3% and 108.9 months, respectively, in those receiving C-HT ( p = 0.03). This benefit remained significant on multivariable analysis (hazard ratio 0.86, 95% confidence interval 0.77-0.96, p = 0.008). Duration of ADT was not available to report. Conclusions External beam radiation therapy with N-HT was associated with improved overall survival compared to C-HT. This study is hypothesis-generating and further studies are needed to best qualify the sequencing of hormone therapy with the duration of treatment.

Comparisons of outcomes for patients with high-risk prostate cancer treated with brachytherapy, external beam radiation, or radical prostatectomy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 63-63
Author(s):  
Jay P. Ciezki ◽  
Harguneet Singh ◽  
Chandana A. Reddy ◽  
Steven C. Campbell ◽  
James Ulchaker ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Multivariable Analysis ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer

63 Background: There is no consensus on how to best treat patients (pts) with high-risk prostate cancer. Methods: The outcomes for 2,736 high-risk prostate cancer pts treated with radical prostatectomy (RP), external beam radiotherapy (RT), and I-125 brachytherapy (BT) at a single institution from 1996 to 2012 were reviewed. The majority of RT pts were treated prior to 2002 because of our preference for RP and BT over time. High-risk was defined per the NCCN criteria. The outcomes assessed were biochemical failure (bF), clinical failure (cF), and prostate cancer mortality (PCM). Results: The distribution by treatment was RP 54%, RT 27%, and BT 19%. The median follow up for all pts was 4.6 years (y) (range 0.1-19.5): 3.8 y (0.1-18.7) for RP, 7.7 y (0.1-19.4) for RT, and 4.1 y (0.1-16.8) for BT pts. No patient received RT+BT, and 44% received androgen deprivation therapy (ADT). On multivariable analysis (see table) RP pts were at higher risk for bF vs. RT; BT pts and RT pts were at higher risk for cF vs. RP; and RT pts were at higher risk for PCM vs. RP. All multivariable analyses were adjusted for clinical stage, biopsy Gleason score, pre-treatment PSA, and duration of ADT. Conclusions: RP is associated with worse bF but better cF and PCM. There is no difference between BT and RT for bF, cF, or PCM while BT and RP had similar PCM. These outcomes may be a result of selection bias or differences in follow up time among the three treatment arms so no demonstration of modality superiority is possible. [Table: see text]

scholarly journals Impact of prostate cancer national guidelines on brachytherapy monotherapy practice patterns.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5024-5024
Author(s):  
Yolanda Diana Tseng ◽  
Alan T Paciorek ◽  
Neil E Martin ◽  
Anthony Victor D'Amico ◽  
Matthew R. Cooperberg ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Treatment Options ◽  
The United States ◽  
External Beam Radiation ◽  
Intermediate Risk ◽  
National Guidelines ◽  
Beam Radiation ◽  
Treatment Groups ◽  
Risk Prostate Cancer

5024 Background: In 1999, the American Brachytherapy Society (ABS) recommended brachytherapy monotherapy (BT) be limited to low-risk prostate cancer, in part because a high-impact 1998 publication suggested that intermediate or high-risk disease had worse outcomes with BT than with external beam radiation (EBRT) or radical prostatectomy (RP). We studied temporal patterns of BT use before and after the 1999 ABS published guidelines as compared with 4 other treatment options. Methods: A retrospective analysis was performed of all men with T1c-T3cN0M0 prostate cancer treated definitively in the United States from 1990 to 2011 in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry. Logistic regression was used to estimate adjusted odds ratios (AOR) comparing BT use with other treatment groups between the 1990-1998 and 1999-2011 periods, controlling for age, disease characteristics, and clinic site type. Results: 8128 men received BT (n=1117), BT+EBRT (n=313), EBRT alone (n=596), EBRT+androgen deprivation therapy (ADT, n=613), or RP (n=5489) for modified D’Amico low (n=3506), intermediate (n=2938) or high-risk (n=1684) disease. By t-tests, BT patients were younger than either EBRT or EBRT+ADT patients (both p<0.001), older than RP patients (p<0.001), and had lower risk disease than men in any of the four treatment groups (all Cochran-Mantel-Haenszel chi-square p<0.001). BT comprised 6.1% and 16.6% of all treatments in 1990-1998 and 1999-2011, respectively (Pearson p<0.01). The odds of BT use remained increased after adjusting for potential confounders (AOR 4.50, p<0.001). Increased BT use was seen only among low (AOR 5.06, p<0.001) and intermediate-risk patients (AOR 4.59, p<0.001). Among men with low or intermediate-risk disease, BT use increased compared with EBRT (AORLOW 10.00; AORINT 12.66, both p<0.001), EBRT+ADT (AORLOW 2.90, p=0.0037; AORINT 2.15, p=0.0041) and RP (AORLOW 4.76; AORINT5.10, both p<0.001). Conclusions: Despite national guidelines to the contrary, brachytherapy monotherapy for intermediate-risk prostate cancer increased over time relative to other treatments. Further studies are needed to identify factors that contribute to this evidence-practice gap.

Comorbidity and the risk of all-cause and prostate cancer–specific mortality in men with unfavorable risk prostate cancer undergoing high dose radiation therapy alone.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 207-207
Author(s):  
Mai Anh Huynh ◽  
Ming-Hui Chen ◽  
Jing Wu ◽  
Michelle H. Braccioforte ◽  
Brian Joseph Moran ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Cox Regression ◽  
Low Risk ◽  
External Beam Radiation ◽  
Cancer Center ◽  
High Dose ◽  
Beam Radiation ◽  
Risk Prostate Cancer

207 Background: An association between shortened survival and 6 months of androgen deprivation therapy (ADT) use has been observed in men with moderate to severe comorbidity undergoing external beam radiation therapy (RT) for unfavorable-risk prostate cancer (PC). Whether these men would benefit from treatment with high dose RT alone remains unknown and was explored. Methods: Between October 1997 and May 2013, 7533 men with T1-3NxM0 PC were treated with brachytherapy with or without neoadjuvant RT at the Chicago Prostate Cancer Center. We used competing risks and Cox regression multivariable analyses to evaluate whether the risk of PC-specific and all-cause mortality (PCSM, ACM) were increased in men with unfavorable-intermediate or high risk as compared to favorable-intermediate or low risk PC undergoing brachytherapy adjusting for number of comorbidities (diabetes mellitus, myocardial infarction, congestive heart failure), age at and year of brachytherapy, use of supplemental RT, and an RT treatment propensity score. Results: Of 7533 men treated with curative intent 5737 (76.2%), 1470 (19.5%) and 326 (4.3%) had no, 1, or 2 or more comorbidities respectively. After a median follow up of 7.7 years 958 men died, 81 (8.5%) and 877 (91.5%) of PC and other causes respectively. In the no comorbidity subgroup the risk of PCSM (Adjusted hazard ratio (AHR): 2.39; [95% Confidence interval (CI): 1.32 to 4.31]; p = 0.004) and ACM (AHR: 1.25; [95% CI:1.05 to 1.50]; p= 0.013) were significantly increased in men with unfavorable-intermediate or high-risk PC as compared to favorable-intermediate or low risk PC; however, this was not the case in men with 1 or at least 2 comorbidities as shown in the table. Conclusions: Withholding ADT in men with unfavorable-intermediate or high-risk PC and at least 1 significant comorbidity did not appear to increase the risk of PCSM or shorten survival. [Table: see text]

Comparative effectiveness of surgery versus external beam radiation with/without brachytherapy in intermediate and high-risk localized prostate cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16602-e16602
Author(s):  
Ming Yin ◽  
Paul Monk ◽  
Amir Mortazavi ◽  
Monika Joshi ◽  
Edmund Folefac ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
High Risk ◽  
Old Age ◽  
Survival Benefit ◽  
Risk Group ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation

e16602 Background: Radical prostatectomy (RP) and definitive radiation with androgen deprivation therapy (ADT) are both standard of care options for intermediate and high-risk localized prostate cancer (PCa). It remains controversial if the two modalities produce equivalent outcomes because the PROTECT trial (2016) and three recent retrospective studies (2018) drew inconsistent conclusions. Methods: The Surveillance, Epidemiology and End Results (SEER) database was queried from 2004 to 2015 for localized PCa (TxN0M0) who received upfront surgery or who were recommended for surgery but instead received external beam radiation (EBRT) with or without brachytherapy boost to control selection bias. The Kaplan-Meier method was used to generate overall survival (OS) curves and the Cox regression analysis was performed to compare survival outcomes. Results: A total of 175,349 patients were eligible with a median age of 62 years old (age range: 26 to 99). 167,234 patients had upfront surgery and 8,115 patients had upfront radiotherapy, including 7,099 EBRT and 1,016 EBRT with brachytherapy. Overall, upfront surgery was associated with a better OS, compared with patients who received radiotherapy (all patients: adjusted HR [adjHR], 0.79; 95% CI, 0.74–0.83, P < 0.001). The survival benefit is more pronounced in patients of intermediate-risk group (adjHR, 0.61; 95% CI, 0.57–0.66, P < 0.001; N = 112,816), and remains significant in patients of high-risk group (adjHR, 0.91; 95% CI, 0.84–0.98, P = 0.02; N = 62,533). However, in elderly high-risk PCa patients (age ≥ 70), surgery was associated with a significantly inferior OS, compared with radiotherapy (adjHR, 1.16; 95% CI, 1.06–1.28, P = 0.002). Conclusions: Compared with upfront radiation therapy, definitive surgery was associated with overall survival benefit in intermediate- and high-risk localized PCa, except patients with old age and high-risk features, who should be considered for radiation therapy.

scholarly journals Lymphopenia Is Associated with Gross Target Volumes and Fractions in Hepatocellular Carcinoma Patients Treated with External Beam Radiation Therapy and Also Indicates Worse Overall Survival

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Hai-Ge Zhang ◽  
Ping Yang ◽  
Tao Jiang ◽  
Jian-Ying Zhang ◽  
Xue-Juan Jin ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cox Regression ◽  
External Beam Radiation ◽  
Rank Test ◽  
Beam Radiation ◽  
Kaplan Meier ◽  
Target Volumes ◽  
The Relationship

Purpose. To investigate whether lymphocyte nadir induced by radiation is associated with survival and explore its underlying risk factors in patients with hepatocellular carcinoma (HCC). Methods. Total lymphocyte counts were collected from 184 HCC patients treated by radiotherapy (RT) with complete follow-up. Associations between gross tumor volumes (GTVs) and radiation-associated parameters with lymphocyte nadir were evaluated by Pearson/Spearman correlation analysis and multiple linear regression. Kaplan–Meier analysis, log-rank test, as well as univariate and multivariate Cox regression were performed to assess the relationship between lymphocyte nadir and overall survival (OS). Results. GTVs and fractions were negatively related with lymphocyte nadir (p<0.001 and p=0.001, respectively). Lymphocyte nadir and Barcelona Clinic Liver Cancer (BCLC) stage were independent prognostic factors predicting OS of HCC patients (all p<0.001). Patients in the GTV ≤55.0 cc and fractions ≤16 groups were stratified by lymphocyte nadir, and the group with the higher lymphocyte counts (LCs) showed longer survival than the group with lower LCs (p<0.001 and p=0.006, respectively). Patient distribution significantly differed among the RT fraction groups according to BCLC stage (p<0.001). However, stratification of patients in the same BCLC stage by RT fractionation showed that the stereotactic body RT (SBRT) group achieved the best survival. Furthermore, there were significant differences in lymphocyte nadir among patients in the SBRT group. Conclusions. A lower lymphocyte nadir during RT was associated with worse survival among HCC patients. Smaller GTVs and fractions reduced the risk of lymphopenia.

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