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Pattern of Radiotherapy Treatment in Low-Risk, Intermediate-Risk, and High-Risk Prostate Cancer Patients: Analysis of National Cancer Database

SIMPLE SUMMARY: Prostate cancer (PCa) is the most common cancer and the second leading cause of cancer-related mortality among males in the US. Definitive radiation therapy (RT) plays an important role in curative-intent treatment for localized PCa and can be delivered with several different techniq...

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Autores principales: Agrawal, Rishabh, Dey, Asoke, Datta, Sujay, Nassar, Ana, Grubb, William, Traughber, Bryan, Biswas, Tithi, Ove, Roger, Podder, Tarun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9688758/
https://www.ncbi.nlm.nih.gov/pubmed/36428595
http://dx.doi.org/10.3390/cancers14225503
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author Agrawal, Rishabh
Dey, Asoke
Datta, Sujay
Nassar, Ana
Grubb, William
Traughber, Bryan
Biswas, Tithi
Ove, Roger
Podder, Tarun
author_facet Agrawal, Rishabh
Dey, Asoke
Datta, Sujay
Nassar, Ana
Grubb, William
Traughber, Bryan
Biswas, Tithi
Ove, Roger
Podder, Tarun
author_sort Agrawal, Rishabh
collection PubMed
description SIMPLE SUMMARY: Prostate cancer (PCa) is the most common cancer and the second leading cause of cancer-related mortality among males in the US. Definitive radiation therapy (RT) plays an important role in curative-intent treatment for localized PCa and can be delivered with several different techniques, depending on the availability of resources and patient-specific criteria. With an analysis of the extensive National Cancer Database, this paper investigates trends in utilization, survival probability, and factors associated with overall survival of six common RT modalities utilized for the treatment of PCa patients—stratified by the three risk groups. ABSTRACT: Background: In this study, the utilization rates and survival outcomes of different radiotherapy techniques are compared in prostate cancer (PCa) patients stratified by risk group. Methods: We analyzed an extensive data set of N0, M0, non-surgical PCa patients diagnosed between 2004 and 2015 from the National Cancer Database (NCDB). Patients were grouped into six categories based on RT modality: an intensity-modulated radiation therapy (IMRT) group with brachytherapy (BT) boost, IMRT with/without IMRT boost, proton therapy, stereotactic body radiation therapy (SBRT), low-dose-rate brachytherapy (BT LDR), and high-dose-rate brachytherapy (BT HDR). Patients were also stratified by the National Comprehensive Cancer Network (NCCN) guidelines: low-risk (clinical stage T1–T2a, Gleason Score (GS) ≤ 6, and Prostate-Specific Antigen (PSA) < 10), intermediate-risk (clinical stage T2b or T2c, GS of 7, or PSA of 10–20), and high-risk (clinical stage T3–T4, or GS of 8–10, or PSA > 20). Overall survival (OS) probability was determined using a Kaplan–Meier estimator. Univariate and multivariate analyses were performed by risk group for the six treatment modalities. Results: The most utilized treatment modality for all PCa patients was IMRT (53.1%). Over the years, a steady increase in SBRT utilization was observed, whereas BT HDR usage declined. IMRT-treated patient groups exhibited relatively lower survival probability in all risk categories. A slightly better survival probability was observed for the proton therapy group. Hormonal therapy was used for a large number of patients in all risk groups. Conclusion: This study revealed that IMRT was the most common treatment modality for PCa patients. Brachytherapy, SBRT, and IMRT+BT exhibited similar survival rates, whereas proton showed slightly better overall survival across the three risk groups. However, analysis of the demographics indicates that these differences are at least in part due to selection bias.
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spelling pubmed-96887582022-11-25 Pattern of Radiotherapy Treatment in Low-Risk, Intermediate-Risk, and High-Risk Prostate Cancer Patients: Analysis of National Cancer Database Agrawal, Rishabh Dey, Asoke Datta, Sujay Nassar, Ana Grubb, William Traughber, Bryan Biswas, Tithi Ove, Roger Podder, Tarun Cancers (Basel) Article SIMPLE SUMMARY: Prostate cancer (PCa) is the most common cancer and the second leading cause of cancer-related mortality among males in the US. Definitive radiation therapy (RT) plays an important role in curative-intent treatment for localized PCa and can be delivered with several different techniques, depending on the availability of resources and patient-specific criteria. With an analysis of the extensive National Cancer Database, this paper investigates trends in utilization, survival probability, and factors associated with overall survival of six common RT modalities utilized for the treatment of PCa patients—stratified by the three risk groups. ABSTRACT: Background: In this study, the utilization rates and survival outcomes of different radiotherapy techniques are compared in prostate cancer (PCa) patients stratified by risk group. Methods: We analyzed an extensive data set of N0, M0, non-surgical PCa patients diagnosed between 2004 and 2015 from the National Cancer Database (NCDB). Patients were grouped into six categories based on RT modality: an intensity-modulated radiation therapy (IMRT) group with brachytherapy (BT) boost, IMRT with/without IMRT boost, proton therapy, stereotactic body radiation therapy (SBRT), low-dose-rate brachytherapy (BT LDR), and high-dose-rate brachytherapy (BT HDR). Patients were also stratified by the National Comprehensive Cancer Network (NCCN) guidelines: low-risk (clinical stage T1–T2a, Gleason Score (GS) ≤ 6, and Prostate-Specific Antigen (PSA) < 10), intermediate-risk (clinical stage T2b or T2c, GS of 7, or PSA of 10–20), and high-risk (clinical stage T3–T4, or GS of 8–10, or PSA > 20). Overall survival (OS) probability was determined using a Kaplan–Meier estimator. Univariate and multivariate analyses were performed by risk group for the six treatment modalities. Results: The most utilized treatment modality for all PCa patients was IMRT (53.1%). Over the years, a steady increase in SBRT utilization was observed, whereas BT HDR usage declined. IMRT-treated patient groups exhibited relatively lower survival probability in all risk categories. A slightly better survival probability was observed for the proton therapy group. Hormonal therapy was used for a large number of patients in all risk groups. Conclusion: This study revealed that IMRT was the most common treatment modality for PCa patients. Brachytherapy, SBRT, and IMRT+BT exhibited similar survival rates, whereas proton showed slightly better overall survival across the three risk groups. However, analysis of the demographics indicates that these differences are at least in part due to selection bias. MDPI 2022-11-09 /pmc/articles/PMC9688758/ /pubmed/36428595 http://dx.doi.org/10.3390/cancers14225503 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Agrawal, Rishabh
Dey, Asoke
Datta, Sujay
Nassar, Ana
Grubb, William
Traughber, Bryan
Biswas, Tithi
Ove, Roger
Podder, Tarun
Pattern of Radiotherapy Treatment in Low-Risk, Intermediate-Risk, and High-Risk Prostate Cancer Patients: Analysis of National Cancer Database
title Pattern of Radiotherapy Treatment in Low-Risk, Intermediate-Risk, and High-Risk Prostate Cancer Patients: Analysis of National Cancer Database
title_full Pattern of Radiotherapy Treatment in Low-Risk, Intermediate-Risk, and High-Risk Prostate Cancer Patients: Analysis of National Cancer Database
title_fullStr Pattern of Radiotherapy Treatment in Low-Risk, Intermediate-Risk, and High-Risk Prostate Cancer Patients: Analysis of National Cancer Database
title_full_unstemmed Pattern of Radiotherapy Treatment in Low-Risk, Intermediate-Risk, and High-Risk Prostate Cancer Patients: Analysis of National Cancer Database
title_short Pattern of Radiotherapy Treatment in Low-Risk, Intermediate-Risk, and High-Risk Prostate Cancer Patients: Analysis of National Cancer Database
title_sort pattern of radiotherapy treatment in low-risk, intermediate-risk, and high-risk prostate cancer patients: analysis of national cancer database
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9688758/
https://www.ncbi.nlm.nih.gov/pubmed/36428595
http://dx.doi.org/10.3390/cancers14225503
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