Background

There are limited comparative survival data for prostate cancer (PCa) patients managed with a low-dose rate brachytherapy (LDR-B) boost and dose-escalated external-beam radiotherapy (DE-EBRT) alone.

Objective

To compare overall survival (OS) for men with unfavorable PCa between LDR-B and DE-EBRT groups.

Design, setting, and participants

Using the National Cancer Data Base, we identified men with unfavorable PCa treated between 2004 and 2012 with androgen suppression (AS) and either EBRT followed by LDR-B or DE-EBRT (75.6–86.4 Gy).

Outcome measurements and statistical analysis

Treatment selection was evaluated using logistic regression and annual percentage proportions. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards, and propensity score matching.

Results and limitation

We identified 25 038 men between 2004 and 2012, during which LDR-B boost utilization decreased from 29% to 14%. LDR-B was associated with better OS on univariate (7-yr OS: 82% vs 73%; p < 0.001) and multivariate analyses (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.64–0.77). Propensity score matching verified an OS benefit associated with LDR-B boost (HR 0.74, 95% CI 0.66–0.89). The OS benefit of LDR-B boost persisted when limited to men aged <60 yr with no comorbidities. On subset analysis, there was no interaction between treatment and age, risk group, or radiation dose. Limitations include the retrospective design, nonrandomized selection bias, and the absence of treatment toxicity, hormone duration, and cancer-specific outcomes.

Conclusions

Between 2004 and 2012, LDR-B boost utilization declined and was associated with better OS compared to DE-EBRT alone. LDR-B boost is probably the ideal treatment option for men with unfavorable PCa, pending long-term results of randomized trials.

Patient summary

We compared radiotherapy utilization and survival for prostate cancer (PCa) patients using a national database. We found that low-dose rate brachytherapy (LDR-B) boost, a method being used less frequently, was associated with better overall survival when compared to dose-escalated external-beam radiotherapy alone for men with unfavorable PCa. Randomized trials are needed to confirm that LDR-B boost is the ideal treatment.

中文翻译：

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近距离放射疗法可提高不良风险前列腺癌的利用和生存率。

背景

对于仅接受低剂量率近距离放射治疗（LDR-B）增强和剂量递增外照射（DE-EBRT）治疗的前列腺癌（PCa）患者，其相对生存数据有限。

客观的

比较LDR-B和DE-EBRT组PCa不良的男性的总生存期（OS）。

设计，设置和参与者

利用美国国家癌症数据库，我们确定了2004年至2012年间接受PCa治疗不良的男性，接受了雄激素抑制（AS）和EBRT，其次是LDR-B或DE-EBRT（75.6-86.4 Gy）。

成果测量和统计分析

使用逻辑回归和年度百分比比例评估治疗选择。使用Kaplan-Meier方法，对数秩检验，Cox比例风险和倾向得分匹配对OS进行了分析。

结果与局限性

我们确定了2004年至2012年之间的25038名男性，在此期间，LDR-B的使用率从29％下降至14％。LDR-B与单因素（7年OS：82％vs 73％；p  <0.001）和多因素分析（危险比[HR] 0.70，95％置信区间[CI] 0.64–0.77）时更好的OS相关。倾向得分匹配证明了与LDR-B增强相关的OS获益（HR 0.74，95％CI 0.66-0.89）。当限于年龄小于60岁且无合并症的男性时，LDR-B增强的OS益处持续存在。在子集分析中，治疗与年龄，风险组或放射剂量之间没有相互作用。局限性包括回顾性设计，非随机选择偏倚以及缺乏治疗毒性，激素持续时间和癌症特异性结局。

结论

在2004年至2012年之间，与仅使用DE-EBRT相比，LDR-B的利用率提高有所下降，并且与更好的OS相关。对于不良PCa的男性，LDR-B加强免疫可能是理想的治疗选择，有待于随机试验的长期结果。

病人总结

我们使用国家数据库比较了前列腺癌（PCa）患者的放射疗法利用率和生存率。我们发现，对于PCa不良的男性，与仅采用剂量递增的体外束放射疗法相比，低剂量近距离放射疗法（LDR-B）加强疗法（一种较少使用的方法）与更好的总体生存率相关。需要进行随机试验以确认LDR-B加强免疫是理想的治疗方法。