Yu-Wei Chen1, Vinayak Muralidhar2, Brandon A Mahal3, Michelle D Nezolosky1, Clair J Beard1, Toni K Choueiri4, Karen E Hoffman5, Neil E Martin1, Peter F Orio1, Christopher J Sweeney4, Felix Y Feng6, Quoc-Dien Trinh7, Paul L Nguyen8. 1. Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA. 2. Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA. 3. Department of Medicine, Brigham and Women's Hospital, Boston, MA. 4. Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA. 5. Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX. 6. Department of Radiation Oncology, University of California, San Francisco, CA; Department of Urology, University of California, San Francisco, CA; Department of Medicine, University of California, San Francisco, CA. 7. Department of Surgery, Division of Urology, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA. 8. Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA. Electronic address: pnguyen@LROC.harvard.edu.
Abstract
PURPOSE: Androgen deprivation therapy (ADT) has been shown to improve survival for men with unfavorable-risk prostate cancer (PCa). We investigated the utilization and factors associated with the omission of ADT in radiation-managed high-risk PCa. METHODS AND MATERIALS: We used the National Cancer Database to identify men with National Comprehensive Cancer Network high-risk PCa treated with external beam radiation therapy (EBRT) with or without brachytherapy boost from 2004 to 2012. Multivariable logistic regression adjusting for clinical and sociodemographic factors was used to identify independent predictors for ADT use. RESULTS: A total of 57,968 radiation-treated high-risk PCa men were included in our analysis. There were 49,363 patients (85.2%) treated with EBRT alone and 8605 patients (14.8%) treated with EBRT plus brachytherapy boost. Overall, 77% of men received ADT. In multivariable regression analysis, the use of brachytherapy boost was associated with a significantly lower utilization of ADT (70% vs. 78%; adjusted odds ratio [AOR]: 0.65; 95% CI: 0.62-0.69; p-Value <0.0001), as was treatment at an academic vs. nonacademic center (AOR: 0.90; 95% CI: 0.86-0.95; p-Value <0.0001) and treatment in 2010-2012 compared to 2004-2006 (AOR: 0.85; 95% CI: 0.81-0.90; p-Value <0.0001). Conversely, greater ADT use was seen with higher Gleason scores, PSA, and T-category (all p-Values <0.001). CONCLUSIONS: Approximately one in four men with radiation-managed high-risk PCa do not receive ADT, which may reflect concerns about its toxicity profile despite known improvements in overall survival. Practice patterns suggest that some providers believe dose escalation through brachytherapy boost may obviate the need for ADT in some high-risk patients, but this hypothesis requires further testing. Copyright Â
PURPOSE: Androgen deprivation therapy (ADT) has been shown to improve survival for men with unfavorable-risk prostate cancer (PCa). We investigated the utilization and factors associated with the omission of ADT in radiation-managed high-risk PCa. METHODS AND MATERIALS: We used the National Cancer Database to identify men with National Comprehensive Cancer Network high-risk PCa treated with external beam radiation therapy (EBRT) with or without brachytherapy boost from 2004 to 2012. Multivariable logistic regression adjusting for clinical and sociodemographic factors was used to identify independent predictors for ADT use. RESULTS: A total of 57,968 radiation-treated high-risk PCa men were included in our analysis. There were 49,363 patients (85.2%) treated with EBRT alone and 8605 patients (14.8%) treated with EBRT plus brachytherapy boost. Overall, 77% of men received ADT. In multivariable regression analysis, the use of brachytherapy boost was associated with a significantly lower utilization of ADT (70% vs. 78%; adjusted odds ratio [AOR]: 0.65; 95% CI: 0.62-0.69; p-Value <0.0001), as was treatment at an academic vs. nonacademic center (AOR: 0.90; 95% CI: 0.86-0.95; p-Value <0.0001) and treatment in 2010-2012 compared to 2004-2006 (AOR: 0.85; 95% CI: 0.81-0.90; p-Value <0.0001). Conversely, greater ADT use was seen with higher Gleason scores, PSA, and T-category (all p-Values <0.001). CONCLUSIONS: Approximately one in four men with radiation-managed high-risk PCa do not receive ADT, which may reflect concerns about its toxicity profile despite known improvements in overall survival. Practice patterns suggest that some providers believe dose escalation through brachytherapy boost may obviate the need for ADT in some high-risk patients, but this hypothesis requires further testing. Copyright Â
Authors: William C Jackson; Holly E Hartman; Robert T Dess; Sam R Birer; Payal D Soni; Jason W D Hearn; Zachary R Reichert; Amar U Kishan; Brandon A Mahal; Zachary S Zumsteg; Jason A Efstathiou; Samuel Kaffenberger; Todd M Morgan; Rohit Mehra; Timothy N Showalter; Daniel A Krauss; Paul L Nguyen; Matthew J Schipper; Felix Y Feng; Howard M Sandler; Peter J Hoskin; Mack Roach; Daniel E Spratt Journal: J Clin Oncol Date: 2020-05-12 Impact factor: 44.544