Declining use of brachytherapy for the treatment of prostate cancer

Mahmood, Usama; Pugh, Thomas J.; Frank, Steven J.; Levy, Lawrence B.; Walker, Gary V.; Haque, Waqar; Koshy, Matthew; Graber, William; Swanson, David A.; Hoffman, Karen E.; Kuban, Deborah A.; Lee, Andrew

doi:10.1016/j.brachy.2013.08.005

Cited by 70 publications

(58 citation statements)

References 14 publications

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“…In that study, EBRT monotherapy increased from 55.8% to 62%, while all brachytherapy usage decreased from 44.2% to 38.0%. This decrease was significantly more pronounced in low risk patients when compared to other risk groups (p < 0.0001) [5]. Interestingly, they found a decrease of brachytherapy utilization in white patients, whereas our study demonstrated that the odds ratio for brachytherapy was 0.80 (p < 0.001) for black patients and 0.86 (p < 0.001) for other ethnicities.…”

Section: Discussion With Conclusioncontrasting

confidence: 70%

“…The utilization rates in our study are higher than in other reports, which is likely due to different methodologies. The SEER database study looked at global declining rates of brachytherapy amongst all risk groups, but did not detail the relative usage of brachytherapy compared to EBRT by risk group [5]. The aforementioned NCDB study compared brachytherapy usage to all other modalities, including surgery, hormones, and no treatment.…”

Section: Discussion With Conclusionmentioning

confidence: 99%

“…Several possibilities have been suggested to explain this trend, including increased utilization of robotic assisted surgery [12], fewer practitioners being trained, and possibly financial incentives [5]. With IMRT paying almost $15,000 per patient, private physicians may be incentivized to offer longer treatment and avoid pushing brachytherapy [13].…”

Section: Discussion With Conclusionmentioning

confidence: 99%

“…However, this trend has reported to have recently reversed as newer technologies have gained acceptance, such as intensity modulated radiotherapy (IMRT), proton therapy, as well as improvement of surgical options, such as robotic assisted prostatectomy [4,5]. Others have suggested that outside issues, such as financial reimbursement, lack of physician skill proficiency in brachytherapy, as well as stage migration towards more intermediate and high grade disease, which may be less likely to include prostate brachytherapy, have played a role in this trend [6].…”

Section: Purposementioning

confidence: 99%

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Utilization of Prostate Brachytherapy for Low-Risk Prostate Cancer: Is the Decline Overstated?

Safdieh

Schwartz

Osborn

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Several prior studies have suggested that brachytherapy utilization has markedly decreased, coinciding with the recent increased utilization of intensity modulated radiation therapy, as well as an increase in urologist-owned centers. We sought to investigate the brachytherapy utilization in a large, hospital-based registry.Material and methods: Men with prostate cancer diagnosed between 2004-2012 and treated with either external beam radiation and/or prostate brachytherapy were abstracted from the National Cancer Database. In order to be included, men had to be clinically staged as T1c-T2aNx-0Mx-0, Gleason 6, PSA ≤ 10.0 ng/ml. Descriptive statistics were used to analyze brachytherapy utilization over time and were compared via χ 2 . Multivariate logistic regression was used to assess for covariables associated with increased brachytherapy usage.Results: There were 89,413 men included in this study, of which 37,054 (41.6%) received only external beam radiation, and 52,089 (58.4%) received prostate brachytherapy. The use of brachytherapy declined over time from Conclusions: In this hospital-based registry, prostate brachytherapy usage has declined for low risk prostate cancer as intensity modulated radiation therapy usage has increased. However, it still remains the treatment of choice for 51.3% of patients as of 2012.

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Section: Discussion With Conclusioncontrasting

confidence: 70%

Section: Discussion With Conclusionmentioning

confidence: 99%

Section: Discussion With Conclusionmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%

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Utilization of Prostate Brachytherapy for Low-Risk Prostate Cancer: Is the Decline Overstated?

Safdieh

Schwartz

Osborn

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…However, our report provides information on BT results in nearly all patients who underwent LDR-BT in Italy. Reporting these data is now particularly crucial for a realistic comparison with other modalities of radical treatment, such as new surgery and radiotherapy techniques or radiotherapy fractionation schemes, which are rapidly spreading in the community, 26,27 despite a less mature evidence of efficacy and perhaps a higher cost.…”

Section: Discussionmentioning

confidence: 99%

Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

Fellin¹,

Mirri²,

Santoro³

et al. 2016

BJR

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OBJECTIVE:\ud Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure.\ud METHODS:\ud Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes.\ud RESULTS:\ud Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT.\ud CONCLUSION:\ud This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer.\ud ADVANCES IN KNOWLEDGE:\ud Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome

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Trends in the Use of Stereotactic Body Radiotherapy for Treatment of Prostate Cancer in the United States

et al. 2020

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IMPORTANCE Stereotactic body radiotherapy is a hypofractionated, cost-effective treatment option for localized prostate cancer. OBJECTIVE To characterize US national trends and the clinical and socioeconomic factors associated with the use of stereotactic body radiotherapy in prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data collected by the National Cancer Database to assess the clinical and socioeconomic factors among 106 926 men diagnosed as having prostate cancer from 2010 to 2015 who underwent definitive radiotherapy and the trends in the use of this therapy. The initial analysis was performed between January and February 2018, with final updates performed August 2019. EXPOSURE Stereotactic body radiotherapy, defined as 5 fractions of radiotherapy. MAIN OUTCOMES AND MEASURES Temporal trends and clinical and sociodemographic factors associated with stereotactic body radiotherapy use. RESULTS In total, 106 926 patients diagnosed as having localized prostate cancer between 2010 and 2015 and receiving definitive radiotherapy were identified. White patients composed 77.3% of this cohort, whereas black patients composed 18.7%. Government-issued insurance was used by 61.2% of patients. More than 80% of patients had a Charlson-Deyo Comorbidity Index score of 0 (range, 0 to Ն3, with lower numbers indicating fewer comorbidities). In the study population, 25.7% had low-risk disease; 26.3%, favorable intermediate-risk disease; 23.3%, unfavorable intermediaterisk disease; and 24.7%, high-risk disease. The proportion of patients who underwent radiotherapy and received stereotactic body radiotherapy (a total of 5395 patients) increased from 3.1% in 2010 to 7.2% in 2015 (odds ratio, 0.36; 95% CI, 0.33-0.40; P < .001). Among the entire cohort, patients received a median dose of 36.25 Gy (range, 30.00-50.00 Gy). Androgen deprivation therapy use increased significantly as disease risk level increased among all patients receiving radiotherapy (9.5% with low risk to 76.6% with high risk; P = .02) and among those receiving stereotactic body radiotherapy (4.1% with low risk to 33.2% with high risk; P = .04) or not receiving stereotactic body radiotherapy (9.9% with low risk to 77.6% with high risk; P = .04). Patients treated at an academic center, living in an urban area, or possessing higher incomes and those who were healthier, white individuals, or were diagnosed as having lower-risk prostate cancer had higher odds of receiving stereotactic body radiotherapy. CONCLUSIONS AND RELEVANCE This study found that stereotactic body radiotherapy use in prostate cancer more than doubled from 2010 to 2015 but accounted for less than 10% of all patients undergoing radiotherapy. Androgen deprivation therapy use increased with disease risk among patients overall, regardless of receiving stereotactic body radiotherapy. Socioeconomic and clinical (continued) Key Points Question Does an association exist between clinical or socioeconomic factors and selecting stereotactic body radiosurgery to treat pro...

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Declining use of brachytherapy for the treatment of prostate cancer

Cited by 70 publications

References 14 publications

Utilization of Prostate Brachytherapy for Low-Risk Prostate Cancer: Is the Decline Overstated?

Utilization of Prostate Brachytherapy for Low-Risk Prostate Cancer: Is the Decline Overstated?

Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

Trends in the Use of Stereotactic Body Radiotherapy for Treatment of Prostate Cancer in the United States

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