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. 2022 Nov 9;14(22):5503.
doi: 10.3390/cancers14225503.

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

Rishabh Agrawal  1 , Asoke Dey  2 , Sujay Datta  3 , Ana Nassar  1 , William Grubb  1   4 , Bryan Traughber  5 , Tithi Biswas  4   6 , Roger Ove  4   6 , Tarun Podder  4   6
Affiliations

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

Rishabh Agrawal et al. Cancers (Basel). .

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.

Keywords: IMRT; SBRT; brachytherapy; overall survival; prostate cancer; proton-beam therapy; radiotherapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
CONSORT diagram—selection of the prostate cancer patient population from NCDB 2004–2015.
Figure 2
Figure 2
Pattern of utilization of radiation therapy modality for low-risk PCa by treatment modality.
Figure 3
Figure 3
Pattern of utilization of radiation therapy modality for intermediate-risk PCa patients by treatment modality.
Figure 4
Figure 4
Pattern of utilization of radiation therapy modality for high-risk PCa patients by treatment modality.
Figure 5
Figure 5
Kaplan–Meier curve for cumulative survival of low-risk patient prostate cancer (PCa) patients treated with the compared modalities.
Figure 6
Figure 6
Kaplan–Meier curve for cumulative survival of intermediate-risk patient prostate cancer (PCa) patients treated with the compared modalities.
Figure 7
Figure 7
Kaplan–Meier curve for cumulative survival of high-risk patient prostate cancer (PCa) patients treated with the compared modalities.
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