Toxicity and risk factors after combined high-dose-rate brachytherapy and external beam radiation therapy in men ≥75 years with localized prostate cancer

Löser, Anastassia; Carl, Cedric Oliver; Löser, Benjamin; Nagaraj, Yamini; Frenzel, Thorsten; Petersen, Cordula; Krüll, Andreas; Graefen, Markus; Schwarz, Rudolf

doi:10.1007/s00066-018-1380-5

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…[15][16][17] It is also of note that EBRT-related side effects may be especially important to consider in elderly men who were newly diagnosed with mPCa due to higher toxicity rates that have been well documented in elderly prostate cancer patients, relative to their younger counterparts. [18][19][20] In consequence, potential EBRT-related side effects would be in contrast to the aim of maximally increase quality of life in mPCa patients. [21][22][23] Our work has limitations and should be interpreted in the context of its retrospective and population-based design.…”

Section: Discussionmentioning

confidence: 99%

Survival rates with external beam radiation therapy in newly diagnosed elderly metastatic prostate cancer patients

et al. 2021

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Background: The survival benefit of primary external beam radiation therapy (EBRT) has never been formally tested in elderly men who were newly diagnosed with metastatic prostate cancer (mPCa). We hypothesized that elderly patients may not benefit of EBRT to the extent as younger newly diagnosed mPCa patients, due to shorter life expectancy.Methods: We relied on Surveillance, Epidemiology and End Results (2004-2016) to identify elderly newly diagnosed mPCa patients, aged >75 years. Kaplan-Meier, univariable and multivariable Cox regression models, as well as Competing Risks Regression models tested the effect of EBRT versus no EBRT on overall mortality (OM) and cancer-specific mortality (CSM).Results: Of 6556 patients, 1105 received EBRT (16.9%). M1b stage was predominant in both EBRT (n = 823; 74.5%) and no EBRT (n = 3908; 71.7%, p = 0.06) groups, followed by M1c (n = 211; 19.1% vs. n = 1042; 19.1%, p = 1) and M1a (n = 29; 2.6% vs. n = 268; 4.9%, p < 0.01). Median overall survival (OS) was 23 months for EBRT and 23 months for no EBRT (hazard ratio [HR]: 0.97, p = 0.6). Similarly, median cancer-specific survival (CSS) was 29 months for EBRT versus 30 months for no EBRT (HR: 1.04, p = 0.4). After additional multivariable adjustment, EBRT was not associated with lower OM or lower CSM in the entire cohort, as well as after stratification for M1b and M1c substages. Conclusions:In elderly men who were newly diagnosed with mPCa, EBRT does not affect OS or CSS. In consequence, our findings question the added value of local EBRT in elderly newly diagnosed mPCa patients.

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Section: Discussionmentioning

confidence: 99%

Survival rates with external beam radiation therapy in newly diagnosed elderly metastatic prostate cancer patients

et al. 2021

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“…This might result from advances in radiotherapy modalities, such as intensity-modulated radiotherapy (IMRT), which have lower adverse events than three-dimensional conformal radiotherapy ( 18 – 20 ). Additionally, the combination of IMRT and brachytherapy has been shown to achieve a good cancer control rate with lower toxicity ( 21 , 22 ). Moreover, as combination androgen deprivation therapy has been proved to improve survival, particularly in intermediate- and high-risk localized prostate cancer ( 23 , 24 ), combination hormonal therapy has become widely used worldwide.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of surgery and radiotherapy for survival of patients with clinically localized prostate cancer: A population‑based coarsened exact matching retrospective cohort study

et al. 2020

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Radical prostatectomy and radiotherapy are currently the main treatment options for localized prostate cancer. However, no large cohort study comparing surgery and radiation has been performed in Japan or Asia. The objective of the current study was to compare the survival outcomes of patients with clinically localized prostate cancer and in elderly and young patients receiving surgery and radiotherapy. The survival outcomes of patients with localized prostate cancer (age at diagnosis ≤79 years, clinical T1-3) initially treated with surgery or radiotherapy were retrospectively analyzed. Data were collected from the population-based cancer registry of the Kanagawa Prefecture, Japan. A 1:1 coarsened exact matching of age at diagnosis, clinical T stage and cancer differentiation was performed between the two treatment groups. Patients were also categorized into two subgroups by age using a cutoff of 70 years for analysis. The cohort comprised 4,810 patients aged 50-79 years. No significant difference in cancer-specific survival (CSS) was observed between the two groups (P= 0.612). However, the surgery group had significantly better overall survival (OS; P= 0.004). When stratified for age, similar tendencies were observed in the elderly group (aged 70-79 years; CSS, P=0.961 and OS, P=0.007). No significant difference in either CSS or OS was identified in the younger group (P=0.550 and P= 0.408, respectively). Intrinsic deaths were more likely to occur in elderly patients treated with radiotherapy than those undergoing surgery (69.3 vs. 78.2%; P= 0.128). The results indicated that surgery provided significantly better OS than radiotherapy, particularly among the elderly. However, no significant difference was observed in CSS. These results should be interpreted with caution, given that some important factors were unavailable in the present study, such as prostate-specific antigen values and Gleason scores. Prospective trials evaluating these therapies are warranted.

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“…This might result from advances in radiotherapy modalities, for example the intensity-modulated radiotherapy (IMRT), which have lower adverse events than does three-dimensional conformal radiotherapy [19][20][21]. Also, the combination of IMRT and brachytherapy has been shown to achieve a good cancer control rate and lesser toxicity [22,23]. Moreover, as combination androgen deprivation therapy has been proved to improve survival, particularly in intermediate-and high-risk localized prostate cancer [24,25], combination hormonal therapy has become widely used worldwide.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of surgery and radiotherapy for survival of clinically localized prostate cancer patients: A population-based coarsened exact matching retrospective cohort study

Yasui¹,

Sakaguchi²,

Jikuya³

et al. 2019

Preprint

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Background. Radical prostatectomy and radiotherapy are currently the main treatment options for localized prostate cancer. However, not yet a large cohort study of comparison between surgery and radiation has been investigated in Japan nor Asia. Objective of this study was to compare the survival outcome between surgery and radiotherapy among patients with clinically localized prostate cancer and in the elderly and young patients. Methods. We retrospectively evaluated survival outcomes of localized prostate cancer patients (age at diagnosis ≤79 years, cT1-3) initially treated with surgery or radiotherapy. Data were collected from the population-based cancer registry of Kanagawa Prefecture, Japan. A 1:1 coarsened exact matching of age at diagnosis, clinical T stage, and cancer differentiation was made between the two treatment groups. Patients were also categorized into two groups by age at a cut-off of 70 years for analysis. Results. The cohort comprised 4,810 patients aged 50-79 years. No significant difference in CSS was observed between the two groups (p=0.612), but the surgery group had significantly better prognosis in OS (p=0.004). When stratified for age, similar tendencies were seen in the elderly group (aged 70-79 years) (p=0.961 and p=0.007, respectively). By contrast, no significant difference in either CSS or OS was found in the younger group (p=0.550 and p=0.408, respectively). Intrinsic deaths were more likely to occur in elderly patients treated with radiotherapy than in those undergoing surgery (69.3% vs 78.2%, p=0.128).Conclusions. Our data suggests that surgery provided significantly better OS than radiotherapy, particularly among the elderly. However, radiotherapy may be more appropriate in elderly patients due to less invasiveness of the procedure. Prospective trials evaluating these therapies are warranted.

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Toxicity and risk factors after combined high-dose-rate brachytherapy and external beam radiation therapy in men ≥75 years with localized prostate cancer

Cited by 10 publications

References 25 publications

Survival rates with external beam radiation therapy in newly diagnosed elderly metastatic prostate cancer patients

Survival rates with external beam radiation therapy in newly diagnosed elderly metastatic prostate cancer patients

Comparative effectiveness of surgery and radiotherapy for survival of patients with clinically localized prostate cancer: A population‑based coarsened exact matching retrospective cohort study

Comparative effectiveness of surgery and radiotherapy for survival of clinically localized prostate cancer patients: A population-based coarsened exact matching retrospective cohort study

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