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Observational Study
. 2014 Oct 1;120(19):3089-96.
doi: 10.1002/cncr.28856. Epub 2014 Jun 10.

Low rates of adjuvant radiation in patients with nonmetastatic prostate cancer with high-risk pathologic features

Anusha Kalbasi  1 , Samuel Swisher-McClure, Nandita Mitra, Robert Sunderland, Marc C Smaldone, Robert G Uzzo, Justin E Bekelman
Affiliations
Observational Study

Low rates of adjuvant radiation in patients with nonmetastatic prostate cancer with high-risk pathologic features

Anusha Kalbasi et al. Cancer. .

Abstract

Background: The 2013 American Urological Association/American Society for Radiation Oncology consensus guidelines recommend offering adjuvant radiotherapy (RT) after radical prostatectomy in patients with high-risk pathologic features for recurrence. In the current study, the authors examined practice patterns of adjuvant RT use in patients with elevated pathologic risk factors over a time period spanning the publication of supporting randomized evidence.

Methods: Using the National Cancer Data Base, a total of 130,681 patients were identified who underwent surgical resection for prostate cancer between 2004 and 2011 with at least 1 of the following pathologic risk factors for early biochemical failure: pT3a disease or higher, positive surgical margins and/or lymph node-positive disease. Using multivariable logistic regression, the authors examined factors associated with adjuvant RT use including patient, clinical, demographic, and temporal characteristics.

Results: Adjuvant RT was administered to 9.9% of the patients with at least 1 pathologic risk factor. Use of adjuvant RT did not change over the study period (P = .23). On multivariable analysis, we found that patients treated at high-volume surgical facilities were less likely to receive adjuvant RT (15.9% vs 7.8%; odds ratio, 0.58 [95% confidence interval, 0.50-0.65]; P < .0001). Older age, comorbidities, black race, lower income, and lower population density were also associated with lower rates of adjuvant RT.

Conclusions: Use of adjuvant RT is uncommon and remained unchanged between 2004 and 2011. Patients treated at high-volume surgical facilities are less likely to receive adjuvant RT, irrespective of margin status.

Keywords: adjuvant; patterns of care; prostate cancer; radiation; surgical volume.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

The authors made no disclosures.

Figures

Figure 1
Figure 1
Definition of the study cohort is shown. NCDB indicates National Cancer Data Base; EBRT, external beam radiotherapy; BRT, brachytherapy; ADT, androgen deprivation therapy.
Figure 2
Figure 2
Temporal trend of adjuvant radiotherapy (RT) is shown in patients with ≥ 1 high-risk pathologic feature (2004–2011). RCT, randomized controlled trial.
Figure 3
Figure 3
Rates of adjuvant radiotherapy (RT) in patients with ≥1 high-risk pathologic feature is shown by facility surgical volume. Error bars represent 95% confidence intervals.
See this image and copyright information in PMC

References

    1. Thompson IM, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathologically advanced prostate cancer. JAMA. 2006;296:2329–2335. - PubMed
    1. Thompson IM, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol. 2009;181:956–962. - PMC - PubMed
    1. Wiegel T, Bottke D, Steiner U, et al. Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol. 2009;27:2924–2930. - PubMed
    1. Bolla M, van Poppel H, Collette L, et al. Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911) Lancet. 2005;366:572–578. - PubMed
    1. Bolla M, van Poppel H, Tombal B, et al. Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911) Lancet. 2012;380:2018–2027. - PubMed

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