Ten-year survival after High-Dose-Rate Brachytherapy combined with External Beam Radiation Therapy in high-risk prostate cancer: A comparison with the Norwegian SPCG-7 cohort

Ten-year survival after High-Dose-Rate Brachytherapy combined with External Beam Radiation Therapy in high-risk prostate cancer: A comparison with the Norwegian SPCG-7 cohort

Background The survival benefit of dose-escalation with High-Dose-Rate brachytherapy (HDR-BT) boost combined with External Beam Radiotherapy (EBRT) for the treatment of high-risk prostate cancer (PCa) remains debatable. We investigated 10-year PCa-specific mortality (PCSM) and overall mortality (OM)...

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Hauptverfasser: Wedde, Trude Baastad, Småstuen, Milada Cvancarova, Brabrand, Sigmund, Fosså, Sophie Dorothea, Kaasa, Stein, Tafjord, Gunnar, Russnes, Kjell Magne, Hellebust, Taran Paulsen, Lilleby, Wolfgang
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container_title Radiotherapy and oncology
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creator Wedde, Trude Baastad
Småstuen, Milada Cvancarova
Brabrand, Sigmund
Fosså, Sophie Dorothea
Kaasa, Stein
Tafjord, Gunnar
Russnes, Kjell Magne
Hellebust, Taran Paulsen
Lilleby, Wolfgang
description Background The survival benefit of dose-escalation with High-Dose-Rate brachytherapy (HDR-BT) boost combined with External Beam Radiotherapy (EBRT) for the treatment of high-risk prostate cancer (PCa) remains debatable. We investigated 10-year PCa-specific mortality (PCSM) and overall mortality (OM) in high-risk patients treated with HDR-BT/EBRT (calculated EQD2 = 102 Gy) compared to EBRT alone (70 Gy). Methods HDR-BT boosts (10 Gy × 2) were given 2 weeks apart followed by 50 Gy conformal EBRT (2 Gy × 25) to the prostate and seminal vesicles. The HDR-BT/EBRT group (N:325) received Androgen Deprivation Therapy for a median duration of 2 years. The historical control group (N:296), received a median dose of 70 Gy (2 Gy × 35) to the prostate and seminal vesicles with lifelong Anti-Androgen Treatment. For each treatment group PCSM and OM were established by competing-risk analyses and Kaplan–Meier analyses respectively. Differences were evaluated by the logrank test. Independent associations were established by Cox regression analyses. Significance level set to p 
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fullrecord <record><control><sourceid>cristin</sourceid><recordid>TN_cdi_cristin_nora_10852_73949</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>10852_73949</sourcerecordid><originalsourceid>FETCH-cristin_nora_10852_739493</originalsourceid><addsrcrecordid>eNqFjUFOwzAQRS0EEqFwBuYClpym4IQdLYWuUFWyj4Z0WhtaOxqbllyKM-Kg7lnN4r_35kxkeakrqcpSn4tM5fdalvlEXYqrED6UUmNV6Ez81ORkT8gQvvhgD7gD3ERiWNitkU8-kFxhJJgytqaPhhi7Hlq_f7eO1nC00cD8OwkumVPCPaxwbTFa76A-0daBGWpswyd07EMcii26lvgBHodah2lMyl8vfYFXz0faWnTwtpy9SJ0g4zlei4sN7gLdnO5I3D7P69lCtsmP1jXOMza5Ku_GjS6qSVX8T_wCTD5eZQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Ten-year survival after High-Dose-Rate Brachytherapy combined with External Beam Radiation Therapy in high-risk prostate cancer: A comparison with the Norwegian SPCG-7 cohort</title><source>NORA - Norwegian Open Research Archives</source><source>Elsevier ScienceDirect Journals</source><creator>Wedde, Trude Baastad ; Småstuen, Milada Cvancarova ; Brabrand, Sigmund ; Fosså, Sophie Dorothea ; Kaasa, Stein ; Tafjord, Gunnar ; Russnes, Kjell Magne ; Hellebust, Taran Paulsen ; Lilleby, Wolfgang</creator><creatorcontrib>Wedde, Trude Baastad ; Småstuen, Milada Cvancarova ; Brabrand, Sigmund ; Fosså, Sophie Dorothea ; Kaasa, Stein ; Tafjord, Gunnar ; Russnes, Kjell Magne ; Hellebust, Taran Paulsen ; Lilleby, Wolfgang</creatorcontrib><description>Background The survival benefit of dose-escalation with High-Dose-Rate brachytherapy (HDR-BT) boost combined with External Beam Radiotherapy (EBRT) for the treatment of high-risk prostate cancer (PCa) remains debatable. We investigated 10-year PCa-specific mortality (PCSM) and overall mortality (OM) in high-risk patients treated with HDR-BT/EBRT (calculated EQD2 = 102 Gy) compared to EBRT alone (70 Gy). Methods HDR-BT boosts (10 Gy × 2) were given 2 weeks apart followed by 50 Gy conformal EBRT (2 Gy × 25) to the prostate and seminal vesicles. The HDR-BT/EBRT group (N:325) received Androgen Deprivation Therapy for a median duration of 2 years. The historical control group (N:296), received a median dose of 70 Gy (2 Gy × 35) to the prostate and seminal vesicles with lifelong Anti-Androgen Treatment. For each treatment group PCSM and OM were established by competing-risk analyses and Kaplan–Meier analyses respectively. Differences were evaluated by the logrank test. Independent associations were established by Cox regression analyses. Significance level set to p &lt; 0.05. Results Median follow-up was 104 and 120 months for the HDR-BT/EBRT and the EBRT group respectively. A 3.6-fold decreased risk of PCSM (p &lt; 0.01) and a 1.6-fold decreased risk of OM (p = 0.02) in the HDR-BT/EBRT cohort compared to the EBRT-only group were revealed. Ten-year OM and PCSM rates were 16% and 2.5% in the HDR-BT/EBRT group versus 23% and 8.2% in the EBRT-only group respectively. Both treatment modality (HR = 3.59, 95%CI 1.50–8.59) and Gleason score (HR = 2.48, 95%CI 1.18–5.21) were associated with PCSM. Only treatment modality (HR = 1.63, 95%CI = 1.08–2.44) was significantly associated with OM. Conclusions Men with high-risk PCa have a significantly reduced PCSM and OM rates when treated with dose-escalated radiotherapy achieved by HDR-BT/EBRT compared to EBRT alone (70 Gy). A Gleason score of 8–10 was independently associated with increased risk of PCSM. Randomized studies are warranted. Summary Observational study of 10-year survival in high-risk Prostate Cancer (PCa) after High-Dose-Rate brachytherapy combined with External Beam Radiation Therapy (HDR-BT/EBRT) compared to EBRT alone. The combined HDR-BT/EBRT treatment was found to give a 3.6-fold decrease in Prostate Cancer Specific Mortality (PCSM) and a 1.6-fold decrease in Overall Mortality (OM). Gleason score and type of treatment strongly influenced PCSM whereas only treatment modality was associated with OM. The observed benefits of dose-escalation warrant future randomized trials.</description><identifier>ISSN: 0167-8140</identifier><identifier>EISSN: 1879-0887</identifier><language>nor</language><publisher>Elsevier</publisher><ispartof>Radiotherapy and oncology, 2018</ispartof><rights>info:eu-repo/semantics/openAccess</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,4009,26546</link.rule.ids></links><search><creatorcontrib>Wedde, Trude Baastad</creatorcontrib><creatorcontrib>Småstuen, Milada Cvancarova</creatorcontrib><creatorcontrib>Brabrand, Sigmund</creatorcontrib><creatorcontrib>Fosså, Sophie Dorothea</creatorcontrib><creatorcontrib>Kaasa, Stein</creatorcontrib><creatorcontrib>Tafjord, Gunnar</creatorcontrib><creatorcontrib>Russnes, Kjell Magne</creatorcontrib><creatorcontrib>Hellebust, Taran Paulsen</creatorcontrib><creatorcontrib>Lilleby, Wolfgang</creatorcontrib><title>Ten-year survival after High-Dose-Rate Brachytherapy combined with External Beam Radiation Therapy in high-risk prostate cancer: A comparison with the Norwegian SPCG-7 cohort</title><title>Radiotherapy and oncology</title><description>Background The survival benefit of dose-escalation with High-Dose-Rate brachytherapy (HDR-BT) boost combined with External Beam Radiotherapy (EBRT) for the treatment of high-risk prostate cancer (PCa) remains debatable. We investigated 10-year PCa-specific mortality (PCSM) and overall mortality (OM) in high-risk patients treated with HDR-BT/EBRT (calculated EQD2 = 102 Gy) compared to EBRT alone (70 Gy). Methods HDR-BT boosts (10 Gy × 2) were given 2 weeks apart followed by 50 Gy conformal EBRT (2 Gy × 25) to the prostate and seminal vesicles. The HDR-BT/EBRT group (N:325) received Androgen Deprivation Therapy for a median duration of 2 years. The historical control group (N:296), received a median dose of 70 Gy (2 Gy × 35) to the prostate and seminal vesicles with lifelong Anti-Androgen Treatment. For each treatment group PCSM and OM were established by competing-risk analyses and Kaplan–Meier analyses respectively. Differences were evaluated by the logrank test. Independent associations were established by Cox regression analyses. Significance level set to p &lt; 0.05. Results Median follow-up was 104 and 120 months for the HDR-BT/EBRT and the EBRT group respectively. A 3.6-fold decreased risk of PCSM (p &lt; 0.01) and a 1.6-fold decreased risk of OM (p = 0.02) in the HDR-BT/EBRT cohort compared to the EBRT-only group were revealed. Ten-year OM and PCSM rates were 16% and 2.5% in the HDR-BT/EBRT group versus 23% and 8.2% in the EBRT-only group respectively. Both treatment modality (HR = 3.59, 95%CI 1.50–8.59) and Gleason score (HR = 2.48, 95%CI 1.18–5.21) were associated with PCSM. Only treatment modality (HR = 1.63, 95%CI = 1.08–2.44) was significantly associated with OM. Conclusions Men with high-risk PCa have a significantly reduced PCSM and OM rates when treated with dose-escalated radiotherapy achieved by HDR-BT/EBRT compared to EBRT alone (70 Gy). A Gleason score of 8–10 was independently associated with increased risk of PCSM. Randomized studies are warranted. Summary Observational study of 10-year survival in high-risk Prostate Cancer (PCa) after High-Dose-Rate brachytherapy combined with External Beam Radiation Therapy (HDR-BT/EBRT) compared to EBRT alone. The combined HDR-BT/EBRT treatment was found to give a 3.6-fold decrease in Prostate Cancer Specific Mortality (PCSM) and a 1.6-fold decrease in Overall Mortality (OM). Gleason score and type of treatment strongly influenced PCSM whereas only treatment modality was associated with OM. The observed benefits of dose-escalation warrant future randomized trials.</description><issn>0167-8140</issn><issn>1879-0887</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>3HK</sourceid><recordid>eNqFjUFOwzAQRS0EEqFwBuYClpym4IQdLYWuUFWyj4Z0WhtaOxqbllyKM-Kg7lnN4r_35kxkeakrqcpSn4tM5fdalvlEXYqrED6UUmNV6Ez81ORkT8gQvvhgD7gD3ERiWNitkU8-kFxhJJgytqaPhhi7Hlq_f7eO1nC00cD8OwkumVPCPaxwbTFa76A-0daBGWpswyd07EMcii26lvgBHodah2lMyl8vfYFXz0faWnTwtpy9SJ0g4zlei4sN7gLdnO5I3D7P69lCtsmP1jXOMza5Ku_GjS6qSVX8T_wCTD5eZQ</recordid><startdate>2018</startdate><enddate>2018</enddate><creator>Wedde, Trude Baastad</creator><creator>Småstuen, Milada Cvancarova</creator><creator>Brabrand, Sigmund</creator><creator>Fosså, Sophie Dorothea</creator><creator>Kaasa, Stein</creator><creator>Tafjord, Gunnar</creator><creator>Russnes, Kjell Magne</creator><creator>Hellebust, Taran Paulsen</creator><creator>Lilleby, Wolfgang</creator><general>Elsevier</general><scope>3HK</scope></search><sort><creationdate>2018</creationdate><title>Ten-year survival after High-Dose-Rate Brachytherapy combined with External Beam Radiation Therapy in high-risk prostate cancer: A comparison with the Norwegian SPCG-7 cohort</title><author>Wedde, Trude Baastad ; Småstuen, Milada Cvancarova ; Brabrand, Sigmund ; Fosså, Sophie Dorothea ; Kaasa, Stein ; Tafjord, Gunnar ; Russnes, Kjell Magne ; Hellebust, Taran Paulsen ; Lilleby, Wolfgang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-cristin_nora_10852_739493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>nor</language><creationdate>2018</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wedde, Trude Baastad</creatorcontrib><creatorcontrib>Småstuen, Milada Cvancarova</creatorcontrib><creatorcontrib>Brabrand, Sigmund</creatorcontrib><creatorcontrib>Fosså, Sophie Dorothea</creatorcontrib><creatorcontrib>Kaasa, Stein</creatorcontrib><creatorcontrib>Tafjord, Gunnar</creatorcontrib><creatorcontrib>Russnes, Kjell Magne</creatorcontrib><creatorcontrib>Hellebust, Taran Paulsen</creatorcontrib><creatorcontrib>Lilleby, Wolfgang</creatorcontrib><collection>NORA - Norwegian Open Research Archives</collection><jtitle>Radiotherapy and oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wedde, Trude Baastad</au><au>Småstuen, Milada Cvancarova</au><au>Brabrand, Sigmund</au><au>Fosså, Sophie Dorothea</au><au>Kaasa, Stein</au><au>Tafjord, Gunnar</au><au>Russnes, Kjell Magne</au><au>Hellebust, Taran Paulsen</au><au>Lilleby, Wolfgang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ten-year survival after High-Dose-Rate Brachytherapy combined with External Beam Radiation Therapy in high-risk prostate cancer: A comparison with the Norwegian SPCG-7 cohort</atitle><jtitle>Radiotherapy and oncology</jtitle><date>2018</date><risdate>2018</risdate><issn>0167-8140</issn><eissn>1879-0887</eissn><abstract>Background The survival benefit of dose-escalation with High-Dose-Rate brachytherapy (HDR-BT) boost combined with External Beam Radiotherapy (EBRT) for the treatment of high-risk prostate cancer (PCa) remains debatable. We investigated 10-year PCa-specific mortality (PCSM) and overall mortality (OM) in high-risk patients treated with HDR-BT/EBRT (calculated EQD2 = 102 Gy) compared to EBRT alone (70 Gy). Methods HDR-BT boosts (10 Gy × 2) were given 2 weeks apart followed by 50 Gy conformal EBRT (2 Gy × 25) to the prostate and seminal vesicles. The HDR-BT/EBRT group (N:325) received Androgen Deprivation Therapy for a median duration of 2 years. The historical control group (N:296), received a median dose of 70 Gy (2 Gy × 35) to the prostate and seminal vesicles with lifelong Anti-Androgen Treatment. For each treatment group PCSM and OM were established by competing-risk analyses and Kaplan–Meier analyses respectively. Differences were evaluated by the logrank test. Independent associations were established by Cox regression analyses. Significance level set to p &lt; 0.05. Results Median follow-up was 104 and 120 months for the HDR-BT/EBRT and the EBRT group respectively. A 3.6-fold decreased risk of PCSM (p &lt; 0.01) and a 1.6-fold decreased risk of OM (p = 0.02) in the HDR-BT/EBRT cohort compared to the EBRT-only group were revealed. Ten-year OM and PCSM rates were 16% and 2.5% in the HDR-BT/EBRT group versus 23% and 8.2% in the EBRT-only group respectively. Both treatment modality (HR = 3.59, 95%CI 1.50–8.59) and Gleason score (HR = 2.48, 95%CI 1.18–5.21) were associated with PCSM. Only treatment modality (HR = 1.63, 95%CI = 1.08–2.44) was significantly associated with OM. Conclusions Men with high-risk PCa have a significantly reduced PCSM and OM rates when treated with dose-escalated radiotherapy achieved by HDR-BT/EBRT compared to EBRT alone (70 Gy). A Gleason score of 8–10 was independently associated with increased risk of PCSM. Randomized studies are warranted. Summary Observational study of 10-year survival in high-risk Prostate Cancer (PCa) after High-Dose-Rate brachytherapy combined with External Beam Radiation Therapy (HDR-BT/EBRT) compared to EBRT alone. The combined HDR-BT/EBRT treatment was found to give a 3.6-fold decrease in Prostate Cancer Specific Mortality (PCSM) and a 1.6-fold decrease in Overall Mortality (OM). Gleason score and type of treatment strongly influenced PCSM whereas only treatment modality was associated with OM. The observed benefits of dose-escalation warrant future randomized trials.</abstract><pub>Elsevier</pub><oa>free_for_read</oa></addata></record>
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title Ten-year survival after High-Dose-Rate Brachytherapy combined with External Beam Radiation Therapy in high-risk prostate cancer: A comparison with the Norwegian SPCG-7 cohort
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