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. 2022 Aug;198(8):735-743.
doi: 10.1007/s00066-022-01953-y. Epub 2022 May 12.

Propensity score-matched analysis comparing dose-escalated intensity-modulated radiation therapy versus external beam radiation therapy plus high-dose-rate brachytherapy for localized prostate cancer

Jörg Tamihardja  1 , Ingulf Lawrenz  2 , Paul Lutyj  2 , Stefan Weick  2 , Matthias Guckenberger  3 , Bülent Polat  2 , Michael Flentje  2
Affiliations

Propensity score-matched analysis comparing dose-escalated intensity-modulated radiation therapy versus external beam radiation therapy plus high-dose-rate brachytherapy for localized prostate cancer

Jörg Tamihardja et al. Strahlenther Onkol. 2022 Aug.

Abstract

Purpose: Dose-escalated external beam radiation therapy (EBRT) and EBRT + high-dose-rate brachytherapy (HDR-BT) boost are guideline-recommended treatment options for localized prostate cancer. The purpose of this study was to compare long-term outcome and toxicity of dose-escalated EBRT versus EBRT + HDR-BT boost.

Methods: From 2002 to 2019, 744 consecutive patients received either EBRT or EBRT + HDR-BT boost, of whom 516 patients were propensity score matched. Median follow-up was 95.3 months. Cone beam CT image-guided EBRT consisted of 33 fractions of intensity-modulated radiation therapy with simultaneous integrated boost up to 76.23 Gy (DMean). Combined treatment was delivered as 46 Gy (DMean) EBRT, followed by two fractions HDR-BT boost with 9 Gy (D90%). Propensity score matching was applied before analysis of the primary endpoint, estimated 10-year biochemical relapse-free survival (bRFS), and the secondary endpoints metastasis-free survival (MFS) and overall survival (OS). Prognostic parameters were analyzed by Cox proportional hazard modelling. Genitourinary (GU)/gastrointestinal (GI) toxicity evaluation used the Common Toxicity Criteria for Adverse Events (v5.0).

Results: The estimated 10-year bRFS was 82.0% vs. 76.4% (p = 0.075) for EBRT alone versus combined treatment, respectively. The estimated 10-year MFS was 82.9% vs. 87.0% (p = 0.195) and the 10-year OS was 65.7% vs. 68.9% (p = 0.303), respectively. Cumulative 5‑year late GU ≥ grade 2 toxicities were seen in 23.6% vs. 19.2% (p = 0.086) and 5‑year late GI ≥ grade 2 toxicities in 11.1% vs. 5.0% of the patients (p = 0.002); cumulative 5‑year late grade 3 GU toxicity occurred in 4.2% vs. 3.6% (p = 0.401) and GI toxicity in 1.0% vs. 0.3% (p = 0.249), respectively.

Conclusion: Both treatment groups showed excellent long-term outcomes with low rates of severe toxicity.

Keywords: Dose escalation; High-dose-rate brachytherapy boost; Long-term outcome; Propensity score matching; Toxicity.

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Conflict of interest statement

J. Tamihardja, I. Lawrenz, P. Lutyj, S. Weick, M. Guckenberger, B. Polat, and M. Flentje declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the propensity score-matched analysis comparing prostate external beam radiation therapy versus external beam radiation therapy + high-dose-rate brachytherapy boost. PSA prostate-specific antigen
Fig. 2
Fig. 2
Kaplan–Meier curves for biochemical relapse-free survival for external beam radiation therapy (EBRT, red line) versus external beam radiation therapy + high-dose-rate brachytherapy boost (EBRT + HDR-BT, blue line) after propensity score matching, with corresponding 95% confidence intervals
Fig. 3
Fig. 3
Kaplan–Meier curves for metastasis-free survival for external beam radiation therapy (EBRT, red line) versus external beam radiation therapy + high-dose-rate brachytherapy boost (EBRT + HDR-BT, blue line) after propensity score matching, with corresponding 95% confidence intervals
Fig. 4
Fig. 4
Kaplan–Meier curves for overall survival for external beam radiation therapy (EBRT, red line) versus external beam radiation therapy + high-dose-rate brachytherapy boost (EBRT + HDR-BT, blue line) after propensity score matching, with corresponding 95% confidence intervals
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