External Beam Radiation Therapy With or Without Brachytherapy Boost in Men With Very-High-Risk Prostate Cancer: A Large Multicenter International Consortium Analysis
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External Beam Radiation Therapy With or Without Brachytherapy Boost in Men With Very-High-Risk Prostate Cancer: A Large Multicenter International Consortium Analysis. / Patel, Sagar A; Ma, Ting Martin; Wong, Jessica K; Stish, Bradley J; Dess, Robert T; Pilar, Avinash; Reddy, Chandana; Wedde, Trude B; Lilleby, Wolfgang A; Fiano, Ryan; Merrick, Gregory S; Stock, Richard G; Demanes, D Jeffrey; Moran, Brian J; Tran, Phuoc T; Krauss, Daniel J; Abu-Isa, Eyad I; Pisansky, Thomas M; Choo, C Richard; Song, Daniel Y; Greco, Stephen; Deville, Curtiland; DeWeese, Theodore L; Tilki, Derya; Ciezki, Jay P; Karnes, R Jeffrey; Nickols, Nicholas G; Rettig, Matthew B; Feng, Felix Y; Berlin, Alejandro; Tward, Jonathan D; Davis, Brian J; Reiter, Robert E; Boutros, Paul C; Romero, Tahmineh; Horwitz, Eric M; Tendulkar, Rahul D; Steinberg, Michael L; Spratt, Daniel E; Xiang, Michael; Kishan, Amar U.
In: INT J RADIAT ONCOL, Vol. 115, No. 3, 01.03.2023, p. 645-653.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - External Beam Radiation Therapy With or Without Brachytherapy Boost in Men With Very-High-Risk Prostate Cancer: A Large Multicenter International Consortium Analysis
AU - Patel, Sagar A
AU - Ma, Ting Martin
AU - Wong, Jessica K
AU - Stish, Bradley J
AU - Dess, Robert T
AU - Pilar, Avinash
AU - Reddy, Chandana
AU - Wedde, Trude B
AU - Lilleby, Wolfgang A
AU - Fiano, Ryan
AU - Merrick, Gregory S
AU - Stock, Richard G
AU - Demanes, D Jeffrey
AU - Moran, Brian J
AU - Tran, Phuoc T
AU - Krauss, Daniel J
AU - Abu-Isa, Eyad I
AU - Pisansky, Thomas M
AU - Choo, C Richard
AU - Song, Daniel Y
AU - Greco, Stephen
AU - Deville, Curtiland
AU - DeWeese, Theodore L
AU - Tilki, Derya
AU - Ciezki, Jay P
AU - Karnes, R Jeffrey
AU - Nickols, Nicholas G
AU - Rettig, Matthew B
AU - Feng, Felix Y
AU - Berlin, Alejandro
AU - Tward, Jonathan D
AU - Davis, Brian J
AU - Reiter, Robert E
AU - Boutros, Paul C
AU - Romero, Tahmineh
AU - Horwitz, Eric M
AU - Tendulkar, Rahul D
AU - Steinberg, Michael L
AU - Spratt, Daniel E
AU - Xiang, Michael
AU - Kishan, Amar U
N1 - Copyright © 2022 Elsevier Inc. All rights reserved.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - PURPOSE: Very-high-risk (VHR) prostate cancer (PC) is an aggressive subgroup with high risk of distant disease progression. Systemic treatment intensification with abiraterone or docetaxel reduces PC-specific mortality (PCSM) and distant metastasis (DM) in men receiving external beam radiation therapy (EBRT) with androgen deprivation therapy (ADT). Whether prostate-directed treatment intensification with the addition of brachytherapy (BT) boost to EBRT with ADT improves outcomes in this group is unclear.METHODS AND MATERIALS: This cohort study from 16 centers across 4 countries included men with VHR PC treated with either dose-escalated EBRT with ≥24 months of ADT or EBRT + BT boost with ≥12 months of ADT. VHR was defined by National Comprehensive Cancer Network (NCCN) criteria (clinical T3b-4, primary Gleason pattern 5, or ≥2 NCCN high-risk features), and results were corroborated in a subgroup of men who met Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trials inclusion criteria (≥2 of the following: clinical T3-4, Gleason 8-10, or PSA ≥40 ng/mL). PCSM and DM between EBRT and EBRT + BT were compared using inverse probability of treatment weight-adjusted Fine-Gray competing risk regression.RESULTS: Among the entire cohort, 270 underwent EBRT and 101 EBRT + BT. After a median follow-up of 7.8 years, 6.7% and 5.9% of men died of PC and 16.3% and 9.9% had DM after EBRT and EBRT + BT, respectively. There was no significant difference in PCSM (sHR, 1.47 [95% CI, 0.57-3.75]; P = .42) or DM (sHR, 0.72, [95% CI, 0.30-1.71]; P = .45) between EBRT + BT and EBRT. Results were similar within the STAMPEDE-defined VHR subgroup (PCSM: sHR, 1.67 [95% CI, 0.48-5.81]; P = .42; DM: sHR, 0.56 [95% CI, 0.15-2.04]; P = .38).CONCLUSIONS: In this VHR PC cohort, no difference in clinically meaningful outcomes was observed between EBRT alone with ≥24 months of ADT compared with EBRT + BT with ≥12 months of ADT. Comparative analyses in men treated with intensified systemic therapy are warranted.
AB - PURPOSE: Very-high-risk (VHR) prostate cancer (PC) is an aggressive subgroup with high risk of distant disease progression. Systemic treatment intensification with abiraterone or docetaxel reduces PC-specific mortality (PCSM) and distant metastasis (DM) in men receiving external beam radiation therapy (EBRT) with androgen deprivation therapy (ADT). Whether prostate-directed treatment intensification with the addition of brachytherapy (BT) boost to EBRT with ADT improves outcomes in this group is unclear.METHODS AND MATERIALS: This cohort study from 16 centers across 4 countries included men with VHR PC treated with either dose-escalated EBRT with ≥24 months of ADT or EBRT + BT boost with ≥12 months of ADT. VHR was defined by National Comprehensive Cancer Network (NCCN) criteria (clinical T3b-4, primary Gleason pattern 5, or ≥2 NCCN high-risk features), and results were corroborated in a subgroup of men who met Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trials inclusion criteria (≥2 of the following: clinical T3-4, Gleason 8-10, or PSA ≥40 ng/mL). PCSM and DM between EBRT and EBRT + BT were compared using inverse probability of treatment weight-adjusted Fine-Gray competing risk regression.RESULTS: Among the entire cohort, 270 underwent EBRT and 101 EBRT + BT. After a median follow-up of 7.8 years, 6.7% and 5.9% of men died of PC and 16.3% and 9.9% had DM after EBRT and EBRT + BT, respectively. There was no significant difference in PCSM (sHR, 1.47 [95% CI, 0.57-3.75]; P = .42) or DM (sHR, 0.72, [95% CI, 0.30-1.71]; P = .45) between EBRT + BT and EBRT. Results were similar within the STAMPEDE-defined VHR subgroup (PCSM: sHR, 1.67 [95% CI, 0.48-5.81]; P = .42; DM: sHR, 0.56 [95% CI, 0.15-2.04]; P = .38).CONCLUSIONS: In this VHR PC cohort, no difference in clinically meaningful outcomes was observed between EBRT alone with ≥24 months of ADT compared with EBRT + BT with ≥12 months of ADT. Comparative analyses in men treated with intensified systemic therapy are warranted.
KW - Male
KW - Humans
KW - Brachytherapy/methods
KW - Prostatic Neoplasms/drug therapy
KW - Cohort Studies
KW - Androgen Antagonists/therapeutic use
KW - Neoplasm Grading
KW - Retrospective Studies
U2 - 10.1016/j.ijrobp.2022.09.075
DO - 10.1016/j.ijrobp.2022.09.075
M3 - SCORING: Journal article
C2 - 36179990
VL - 115
SP - 645
EP - 653
JO - INT J RADIAT ONCOL
JF - INT J RADIAT ONCOL
SN - 0360-3016
IS - 3
ER -