Gregory S Merrick1, Kent E Wallner2, Robert W Galbreath3, Wayne M Butler4, Edward Adamovich5. 1. Department of Radiation Oncology, Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV; Department of Urology, Wheeling Hospital, Wheeling, WV. Electronic address: gmerrick@urologicresearchinstitute.org. 2. Department of Radiation Oncology, Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA. 3. Department of Radiation Oncology, Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV; Ohio Univeristy Eastern, St. Clairsville, OH. 4. Department of Radiation Oncology, Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV. 5. Department of Pathology, Wheeling Hospital, Wheeling, WV.
Abstract
PURPOSE: To evaluate whether supplemental external beam radiotherapy (EBRT) is essential to maximize Pd-103 brachytherapy outcomes in patients with unfavorable intermediate-risk (IR) disease. METHODS AND MATERIALS: A total of 630 patients were assessed from two prospective randomized brachytherapy trials evaluating the role of supplemental EBRT in patients with higher risk features. Patients were stratified into unfavorable IR (primary Gleason pattern 4, ≥50% positive biopsies, or ≥2 IR features), favorable IR, and high-risk (HR) cohorts. Median follow-up was 7.5 years. The brachytherapy prescription dose was prescribed to the prostate gland with generous periprostatic margins. Biochemical failure (BF) was defined as a prostate-specific antigen >0.40 ng/mL after nadir. Patients with metastatic prostate cancer or nonmetastatic castrate-resistant disease who died of any cause were classified as dead of prostate cancer. Multiple parameters were evaluated for effect on outcomes. RESULTS: The 10-year BF for favorable IR, unfavorable IR, and HR was 1.7%, 6.6%, and 15.5% (p < 0.001). At 10 years, prostate cancer-specific mortality (PCSM) and overall mortality (OM) were 0% and 20.4%, 2.1% and 23.2%, and 4.3% and 42.4% for favorable IR, unfavorable IR, and HR. Although unfavorable IR patients had a greater incidence of BF, PCSM, and OM when compared with favorable IR, neither the addition nor dose of supplemental EBRT influenced outcome. CONCLUSIONS: Outcomes for favorable IR were superior to those with unfavorable IR. Within the confines of this study, neither the addition nor dose of supplemental EBRT influenced BF, PCSM, or OM in patients with IR disease.
RCT Entities:
PURPOSE: To evaluate whether supplemental external beam radiotherapy (EBRT) is essential to maximize Pd-103 brachytherapy outcomes in patients with unfavorable intermediate-risk (IR) disease. METHODS AND MATERIALS: A total of 630 patients were assessed from two prospective randomized brachytherapy trials evaluating the role of supplemental EBRT in patients with higher risk features. Patients were stratified into unfavorable IR (primary Gleason pattern 4, ≥50% positive biopsies, or ≥2 IR features), favorable IR, and high-risk (HR) cohorts. Median follow-up was 7.5 years. The brachytherapy prescription dose was prescribed to the prostate gland with generous periprostatic margins. Biochemical failure (BF) was defined as a prostate-specific antigen >0.40 ng/mL after nadir. Patients with metastatic prostate cancer or nonmetastatic castrate-resistant disease who died of any cause were classified as dead of prostate cancer. Multiple parameters were evaluated for effect on outcomes. RESULTS: The 10-year BF for favorable IR, unfavorable IR, and HR was 1.7%, 6.6%, and 15.5% (p < 0.001). At 10 years, prostate cancer-specific mortality (PCSM) and overall mortality (OM) were 0% and 20.4%, 2.1% and 23.2%, and 4.3% and 42.4% for favorable IR, unfavorable IR, and HR. Although unfavorable IR patients had a greater incidence of BF, PCSM, and OM when compared with favorable IR, neither the addition nor dose of supplemental EBRT influenced outcome. CONCLUSIONS: Outcomes for favorable IR were superior to those with unfavorable IR. Within the confines of this study, neither the addition nor dose of supplemental EBRT influenced BF, PCSM, or OM in patients with IR disease.
Authors: Vonetta M Williams; Jenna M Kahn; Matthew M Harkenrider; Junzo Chino; Jonathan Chen; L Christine Fang; Emily F Dunn; Emma Fields; Jyoti S Mayadev; Ramesh Rengan; Daniel Petereit; Brandon A Dyer Journal: Brachytherapy Date: 2020-04-21 Impact factor: 2.362
Authors: Silvia Rodríguez Villalba; Paula Monasor Denia; Maria Jose Pérez-Calatayud; Jose Richart Sancho; Jose Pérez-Calatayud; Antonio Fuster Escrivá; Pedro Torrus Tendero; Manuel Santos Ortega Journal: J Contemp Brachytherapy Date: 2021-04-14
Authors: Gregory S Merrick; Ava Tennant; Kent E Wallner; Robert Galbreath; Wayne M Butler; Ryan Fiano; Edward Adamovich Journal: J Contemp Brachytherapy Date: 2017-10-19