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. 2022 Oct 29:38:21-27.
doi: 10.1016/j.ctro.2022.10.010. eCollection 2023 Jan.

Does brachytherapy boost improve survival outcomes in Gleason Grade Group 5 patients treated with external beam radiotherapy and androgen deprivation therapy? A systematic review and meta-analysis

Terence Tang  1 , Stephanie Gulstene  1 , Eric McArthur  1 , Andrew Warner  1 , Gabriel Boldt  1 , Vikram Velker  1 , David D'Souza  1 , Glenn Bauman  1 , Lucas C Mendez  1
Affiliations

Does brachytherapy boost improve survival outcomes in Gleason Grade Group 5 patients treated with external beam radiotherapy and androgen deprivation therapy? A systematic review and meta-analysis

Terence Tang et al. Clin Transl Radiat Oncol. .

Abstract

Background: Localized Gleason Grade Group 5 (GG5) prostate cancer has a poor prognosis and is associated with a higher risk of treatment failure, metastases, and death. Treatment intensification with the addition of a brachytherapy (BT) boost to external beam radiation (EBRT) maximizes local control, which may translate into improved survival outcomes.

Methods: A systematic review and meta-analysis was performed to compare survival outcomes for Gleason GG5 patients treated with androgen deprivation therapy (ADT) and either EBRT or EBRT + BT. The MEDLINE (PubMed), EMBASE and Cochrane databases were searched to identify relevant studies. Survival probabilities for distant metastasis-free survival (DMFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were extracted and pooled to create a summary survival curve for each treatment modality, which were then compared at fixed points in time. An additional analysis was performed among studies directly comparing EBRT and EBRT + BT using a random-effects model.

Results: Eight retrospective studies were selected for inclusion, representing a total of 1393 EBRT patients and 877 EBRT + BT patients. EBRT + BT was associated with higher DMFS starting at 6 years (86.8 % vs 78.8 %; p = 0.018) and extending out to 10 years (81.8 % vs 66.1 %; p < 0.001), with an overall hazard ratio of 0.53 (p = 0.02). There was no difference in PCSS or OS between treatment modalities. Differences in toxicity were not assessed. There was a wide range of heterogeneity between studies.

Conclusion: The addition of BT boost is associated with improved long-term DMFS in Gleason GG5 prostate cancer, but its impact on PCSS and OS remains unclear. These results may be confounded by the heterogeneity across study populations with concern for a risk of bias. Therefore, prospective studies are necessary to further elucidate the survival advantage associated with BT boost, which must ultimately be weighed against the toxicity-related implications of this treatment strategy.

Keywords: Brachytherapy boost; External beam radiotherapy; Gleason Grade Group 5; Prostate cancer; Survival outcome.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic reviews and meta-Analyses (PRISMA) flow diagram. GG5 = Grade Group 5.
Fig. 2
Fig. 2
Pooled distant metastasis-free survival curves by treatment group. CI = confidence interval; EBRT = external beam radiotherapy; EBRT + BT = external beam radiotherapy plus brachytherapy boost.
Fig. 3
Fig. 3
Forest plots for included studies directly comparing EBRT and EBRT + BT. (A) Distant metastasis-free survival. (B) Prostate cancer-specific survival. CI = confidence interval; EBRT = external beam radiotherapy; EBRT + BT = external beam radiotherapy plus brachytherapy boost.
Fig. 4
Fig. 4
Pooled prostate cancer-specific survival curves by treatment group. CI = confidence interval; EBRT = external beam radiotherapy; EBRT + BT = external beam radiotherapy plus brachytherapy boost.
Fig. 5
Fig. 5
Pooled overall survival curves by treatment group. CI = confidence interval; EBRT = external beam radiotherapy; EBRT + BT = external beam radiotherapy plus brachytherapy boost.
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