Impact of national guidelines on brachytherapy monotherapy practice patterns for prostate cancer

Abstract

BACKGROUND In 1999 and 2000, 2 national guidelines recommended brachytherapy monotherapy (BT) primarily for treatment of low‐risk prostate cancer but not high‐risk prostate cancer. This study examined rates of BT use before and after publication of these guidelines, as compared with 4 other treatment options. METHODS From 1990 to 2011, 8128 men with localized prostate cancer (≤ T3cN0M0) were treated definitively within the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry with 1 of 5 primary treatments: BT, external beam radiotherapy (EBRT), EBRT with androgen deprivation therapy, EBRT+BT, or radical prostatectomy. Men were categorized into low‐, intermediate‐, and high‐risk groups based on the guidelines' risk‐group definitions. Within each risk group, logistic regression was used to estimate odds ratios (OR) comparing BT with other treatment options between the 1990‐1998 and 1999‐2011 periods, adjusting for age, disease characteristics, and clinic type. RESULTS In total, 1117 men received BT alone for low‐ (n = 658), intermediate‐ (n = 244), or high‐risk disease (n = 215). BT comprised 6.1% of all treatments in 1990‐1998 versus 16.6% in 1999‐2011 (P < .01). The odds of BT use remained increased after adjusting for potential confounders (OR = 3.06; P < .001) and was seen among low‐ (OR = 4.52; P < .001), intermediate‐ (OR = 2.67; P < .001), and even high‐risk groups (OR = 2.11; P < .001). CONCLUSIONS National guidelines did not appear to influence practice patterns, as BT monotherapy use increased relative to other treatments from the 1990‐1998 to 1999‐2011 periods in unfavorable risk groups including men with high‐risk prostate cancer. Cancer 2014;120:824–832. © 2013 American Cancer Society.

Factors influencing prostate cancer patterns of care: An analysis of treatment variation using the SEER database

“… 11 The CaPSURE database showed a linear decline in BM use between 1999 and 2011. 12 The SEER database also showed a decline in BM between 2004 and 2009. 14 A drop in BM in the HR group could be explained by studies showing inferior results with BM for HR patients, 2 , 15 , 16 and BM is not recommended by 2 national guidelines.…”

“… 12 , 13 Since then, several other studies have shown a decrease in brachytherapy use. 11 , 12 , 14 In the NCDB, the use of brachytherapy for nonmetastatic PC peaked at 16.7% in 2003 and steadily declined to 8.2% in 2010. 11 The CaPSURE database showed a linear decline in BM use between 1999 and 2011.…”

Ablative liver radiotherapy for unresected intrahepatic cholangiocarcinoma: Patterns of care and survival in the United States

“…The recent publication of guidelines recommending A-RT for unresectable ICC may raise awareness, 21 although evidence regarding the influence of guidelines on practice patterns is mixed. [22][23][24][25] Patient advocacy may be another instrument to raise awareness; groups such as the Cholangiocarcinoma Foundation have successfully facilitated research collaborations and may be similarly instrumental in engaging patients and providers to consider referrals for local therapy. 26 Data characterizing survival outcomes following A-RT are limited.…”