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. 2022 Sep-Oct;21(5):617-625.
doi: 10.1016/j.brachy.2022.04.001. Epub 2022 May 28.

Assessing the impact of brachytherapy boost and androgen deprivation therapy on survival outcomes for patients with unfavorable intermediate-risk prostate cancer patients treated with external beam radiotherapy

Neal Andruska  1 , Temitope Agabalogun  2 , Benjamin W Fischer-Valuck  3 , Randall J Brenneman  2 , Yi Huang  4 , Hiram A Gay  2 , Jeff M Michalski  2 , Ruben Carmona  5 , Brian C Baumann  6
Affiliations

Assessing the impact of brachytherapy boost and androgen deprivation therapy on survival outcomes for patients with unfavorable intermediate-risk prostate cancer patients treated with external beam radiotherapy

Neal Andruska et al. Brachytherapy. 2022 Sep-Oct.

Abstract

Background: Current recommendations regarding radiotherapy treatment for unfavorable intermediate-risk prostate cancer (UIR-PCa) include external beam radiotherapy (EBRT) ± brachytherapy boost (BT) ± androgen deprivation therapy (ADT). The ideal radiotherapy treatment approach for UIR-PCa has not been well-defined. We hypothesized that EBRT+BT±ADT is associated with improved overall survival (OS) relative to EBRT±ADT in men with UIR-PCa.

Materials and methods: The National Cancer Database (NCDB) was used to retrospectively identify 32,246 men diagnosed between 2004 and 2015 with UIR-PCa who received EBRT (n = 13,265), EBRT+ADT (n = 13,123), EBRT+BT (n = 3440), or EBRT+BT+ADT (n = 2418). OS was the primary outcome. Inverse probability of treatment weighting was used to adjust for covariable imbalances and weight-adjusted multivariable analysis using Cox regression modeling was used to compare OS hazard ratios.

Results: Median follow-up was 60 months (range: 3-168 months). EBRT+ADT correlated with improved OS relative to EBRT alone on multivariable analysis (Hazard Ratio (HR): 0.92, [95% Confidence Interval: 0.87-0.98], p = 0.005). Compared to EBRT+ADT, EBRT+BT (HR: 0.77 [0.69-0.85], p = 3 × 10-7) and EBRT+BT+ADT (HR: 0.75 [0.67-0.83], p = 6 × 10-8) were associated with improved OS. Eight-years OS for the EBRT+ADT versus EBRT+BT+ADT was 70% and 78% (p < 0.0001), which is similar to historical clinical trials (ASCENDE-RT 9-year OS: 74% vs. 78%, p = 0.29). Relative to EBRT+BT, EBRT+BT+ADT was not associated with improved OS (HR: 0.99 [0.87-1.11], p = 0.82).

Conclusions: In a large retrospective cohort, the addition of brachytherapy to EBRT correlated with improved survival in men with UIR-PCa. Men receiving EBRT+ADT+BT had improved OS relative to EBRT+ADT. The addition of ADT to EBRT, but not to EBRT+BT, correlated with improved OS.

Keywords: Brachytherapy; Intermediate-risk; Prostate cancer; Radiation treatment; Radiotherapy; Unfavorable intermediate-risk.

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Figures

Figure. 1:
Figure. 1:
(A) Unweighted and (B) IPTW weight-adjusted Kaplan-Meier curves stratified by treatment with EBRT, EBRT+ADT, EBRT+BT, and EBRT+BT+ADT. Shading corresponds to 95% confidence intervals. Abbreviations: ADT, androgen deprivation therapy; BT, brachytherapy; EBRT, external beam radiation therapy.
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