Impact of High-Dose-Rate and Low-Dose-Rate Brachytherapy Boost on Toxicity, Functional and Cancer Outcomes in Patients Receiving External Beam Radiation Therapy for Prostate Cancer: A National Population-Based Study.

Published on Apr 1, 2021in International Journal of Radiation Oncology Biology Physics5.859
· DOI :10.1016/J.IJROBP.2020.11.023
Matthew G. Parry8
Estimated H-index: 8
(RCS: Royal College of Surgeons of England),
Julie Nossiter8
Estimated H-index: 8
(RCS: Royal College of Surgeons of England)
+ 9 AuthorsAjay Aggarwal18
Estimated H-index: 18
(Guy's and St Thomas' NHS Foundation Trust)
Sources
Abstract
Purpose External beam radiation therapy (EBRT) with brachytherapy boost reduces cancer recurrence in patients with prostate cancer compared with EBRT monotherapy. However, randomized controlled trials or large-scale observational studies have not compared brachytherapy boost types directly. Methods and Materials This observational cohort study used linked national cancer registry data, radiation therapy data, administrative hospital data, and mortality records of 54,642 patients with intermediate-risk, high-risk, and locally advanced prostate cancer in England. The records of 11,676 patients were also linked to results from a national patient survey collected at least 18 months after diagnosis. Competing risk regression analyses were used to compare gastrointestinal (GI) toxicity, genitourinary (GU) toxicity, skeletal-related events (SRE), and prostate cancer–specific mortality (PCSM) at 5 years with adjustment for patient and tumor characteristics. Linear regression was used to compare Expanded Prostate Cancer Index Composite 26-item version domain scores (scale, 0-100, with higher scores indicating better function). Results Five-year GI toxicity was significantly increased after low-dose-rate brachytherapy boost (LDR-BB) (32.3%) compared with high-dose-rate brachytherapy boost (HDR-BB) (16.7%) or EBRT monotherapy (18.7%). Five-year GU toxicity was significantly increased after both LDR-BB (15.8%) and HDR-BB (16.6%), compared with EBRT monotherapy (10.4%). These toxicity patterns were matched by the mean patient-reported bowel function scores (LDR-BB, 77.3; HDR-BB, 85.8; EBRT monotherapy, 84.4) and the mean patient-reported urinary obstruction/irritation function scores (LDR-BB, 72.2; HDR-BB, 78.9; EBRT monotherapy, 83.8). Five-year incidences of SREs and PCSM were significantly lower after HDR-BB (2.4% and 2.7%, respectively) compared with EBRT monotherapy (2.8% and 3.5%, respectively). Conclusions Compared with EBRT monotherapy, LDR-BB has worse GI and GU toxicity and HDR-BB has worse GU toxicity. HDR-BB has a lower incidence of SREs and PCSM than EBRT monotherapy.
References30
Newest
#1F. Slevin (University of Leeds)H-Index: 3
#2Sree Lakshmi Rodda (Leeds Teaching Hospitals NHS Trust)H-Index: 2
Last. Ann Henry (University of Leeds)H-Index: 32
view all 13 authors...
Abstract Introduction There is evidence to support use of external beam radiotherapy (EBRT) in combination with both low dose rate brachytherapy (LDR–EBRT) and high dose rate brachytherapy (HDR–EBRT) to treat intermediate and high risk prostate cancer. Methods Men with intermediate and high risk prostate cancer treated using LDR–EBRT (treated between 1996 and 2007) and HDR–EBRT (treated between 2007 and 2012) were identified from an institutional database. Multivariable analysis was performed to...
8 CitationsSource
#1Matthew G. Parry (RCS: Royal College of Surgeons of England)H-Index: 8
#2Thomas E Cowling (Lond: University of London)H-Index: 12
Last. Jan van der Meulen (Lond: University of London)H-Index: 61
view all 10 authors...
Abstract Background Non-osteoporotic skeletal-related events (SREs) are clinically important markers of disease progression in prostate cancer. We developed and validated an approach to identify SREs in men with prostate cancer using routinely-collected data. Methods Patients diagnosed with prostate cancer between January 2010 and December 2013 were identified in the National Prostate Cancer Audit, based on English cancer registry data. A coding framework was developed based on diagnostic and pr...
3 CitationsSource
#1Aaron R. Kent (Alfred Hospital)H-Index: 1
#2Bronwyn Matheson (Alfred Hospital)H-Index: 5
Last. Jeremy Millar (Monash University)H-Index: 29
view all 3 authors...
Abstract Purpose High-dose-rate (HDR) brachytherapy boost is a treatment of intermediate- to high-risk prostate cancer, but long-term clinical outcome data are sparse. We report long-term survival and toxicity data in a cohort of patients treated in a single institution. Methods Between 1998 and 2004, 654 patients with localized prostate cancer received either 3-dimensional conformal radiotherapy (median 46 Gy) with an HDR (median 18 Gy in three fractions) boost (“3-D conformal radiotherapy [3DC...
12 CitationsSource
#1Trude B. Wedde (University of Oslo)H-Index: 4
#2Milada Cvancarova Småstuen (HiOA: Oslo and Akershus University College of Applied Sciences)H-Index: 27
Last. Wolfgang Lilleby (Oslo University Hospital)H-Index: 18
view all 9 authors...
Abstract Background The survival benefit of dose-escalation with High-Dose-Rate brachytherapy (HDR-BT) boost combined with External Beam Radiotherapy (EBRT) for the treatment of high-risk prostate cancer (PCa) remains debatable. We investigated 10-year PCa-specific mortality (PCSM) and overall mortality (OM) in high-risk patients treated with HDR-BT/EBRT (calculated EQD2 = 102 Gy) compared to EBRT alone (70 Gy). Methods HDR-BT boosts (10 Gy × 2) were given 2 weeks apart followed by 50 Gy conform...
17 CitationsSource
#1Martin T. King (Harvard University)H-Index: 10
#2David D. Yang (Harvard University)H-Index: 10
Last. Peter F. Orio (Harvard University)H-Index: 17
view all 12 authors...
Abstract Purpose External beam radiation therapy (EBRT) with low-dose-rate (LDR) brachytherapy boost has been associated with improved biochemical progression–free survival and overall survival (OS) compared with dose-escalated EBRT (DE-EBRT) alone for unfavorable-risk prostate cancer. However, it is not known whether high-dose-rate (HDR) boost provides a similar benefit. We compare HDR boost against LDR boost and DE-EBRT with respect to OS. Methods Using the National Cancer Database, we identif...
10 CitationsSource
#1Amar U. Kishan (UCLA: University of California, Los Angeles)H-Index: 19
#2Ryan Cook (UCLA: University of California, Los Angeles)H-Index: 17
Last. Christopher R. King (UCLA: University of California, Los Angeles)H-Index: 37
view all 41 authors...
Importance The optimal treatment for Gleason score 9-10 prostate cancer is unknown. Objective To compare clinical outcomes of patients with Gleason score 9-10 prostate cancer after definitive treatment. Design, Setting, and Participants Retrospective cohort study in 12 tertiary centers (11 in the United States, 1 in Norway), with 1809 patients treated between 2000 and 2013. Exposures Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy, or EBRT plus bra...
156 CitationsSource
#1Ajay Aggarwal (Lond: University of London)H-Index: 18
#2Daniel Lewis (Lond: University of London)H-Index: 13
Last. Jan van der Meulen (RCS: Royal College of Surgeons of England)H-Index: 61
view all 8 authors...
Purpose To investigate whether patients requiring radiation treatment are prepared to travel to alternative more distant centers in response to hospital choice policies, and the factors that influence this mobility. Methods and Materials We present the results of a national cohort study using administrative hospital data for all 44,363 men who were diagnosed with prostate cancer and underwent radical radiation therapy in the English National Health Service between 2010 and 2014. Using geographic...
10 CitationsSource
#1Skyler B. Johnson (Yale University)H-Index: 14
#2Nataniel H. Lester-Coll (Yale University)H-Index: 14
Last. Sameer K. Nath (Yale University)H-Index: 21
view all 6 authors...
Abstract 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 ...
24 CitationsSource
#1Arunan SujenthiranH-Index: 9
#2Julie NossiterH-Index: 8
Last. Ajay Aggarwal (Lond: University of London)H-Index: 18
view all 10 authors...
Purpose To compare, in a national population-based study, severe genitourinary (GU) and gastrointestinal (GI) toxicity in patients with prostate cancer who were treated with radical intensity modulated radiation therapy (IMRT) or 3-dimensional conformal radiation therapy (3D-CRT). Methods and Materials Patients treated with IMRT (n=6933) or 3D-CRT (n=16,289) between January 1, 2010 and December 31, 2013 in the English National Health Service were identified using cancer registry data, the Nation...
24 CitationsSource
#1Ian S. Dayes (McMaster University)H-Index: 18
#2Sameer Parpia (Juravinski Hospital)H-Index: 19
Last. Jinka Sathya (St. John's University)H-Index: 12
view all 7 authors...
Abstract Purpose To determine the impact on long-term survival from the addition of brachytherapy to external beam radiation therapy (EBRT) in patients with prostate cancer. Materials and Methods Between 1992 and 1997, 104 men with cT2-3, surgically staged node-negative prostate cancer were randomized to receive either EBRT (40Gy/20 fractions) with iridium implant (35Gy/48 h) or EBRT alone (66Gy/33 fractions) to the prostate. Based on T- stage, Gleason score and PSA (Prostate-Specific Antigen), ...
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Cited By5
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#1Shuhua Wei (PKU: Peking University)H-Index: 3
#2Chunxiao Li (PKU: Peking University)H-Index: 4
Last. Junjie Wang (PKU: Peking University)H-Index: 18
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Radioactive iodine-125 (I-125) is the most widely used radioactive sealed source for interstitial permanent brachytherapy (BT). BT has the exceptional ability to deliver extremely high doses that external beam radiotherapy (EBRT) could never achieve within treated lesions, with the added benefit that doses drop off rapidly outside the target lesion by minimizing the exposure of uninvolved surrounding normal tissue. Spurred by multiple biological and technological advances, BT application has exp...
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#1Amit Bahl (University Hospitals Bristol NHS Foundation Trust)H-Index: 24
#2Amarnath Challapalli (University Hospitals Bristol NHS Foundation Trust)H-Index: 14
Last. Heather Payne (UCL: University College London)H-Index: 11
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AIM To understand the awareness and use of rectal spacers for prostate cancer patients undergoing radical radiotherapy in the UK. METHODS An expert-devised online questionnaire was completed by members of the British Uro-oncology Group (BUG). RESULTS Sixty-three specialists completed the survey (50% of BUG members at that point in time). Only 37% had used rectal spacers, mostly for private patients or those with pre-existing bowel conditions. However, many (68%) would like to use these devices i...
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#1Darren M. Mitchell (Belfast Health and Social Care Trust)H-Index: 6
#2Suneil Jain (Belfast Health and Social Care Trust)H-Index: 28
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