The decreased use of brachytherapy boost for intermediate and high-risk prostate cancer despite evidence supporting its effectiveness
The decreased use of brachytherapy boost for intermediate and high-risk prostate cancer despite evidence supporting its effectiveness
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DOI：
10.1016/j.brachy.2016.05.001
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发表时间：
2016-11-01
期刊：
影响因子：
1.9
通讯作者：
Chen, Yu-Wei
中科院分区：
文献类型：
--
作者：
Orio, Peter F., III;Nguyen, Paul L.;Chen, Yu-Wei
目的：加拿大雄激素抑制联合选择性淋巴结和剂量递增放射治疗 (ASCENDE-RT) 随机试验表明，与剂量递增放射治疗相比，近距离放射治疗可将复发率降低 50%。我们研究了与 ASCENDE-RT 试验纳入标准相同的男性在美国的治疗情况。 方法和材料：我们使用国家癌症数据库来识别 2004 年至 2012 年期间接受放射治疗的前列腺癌患者，这些患者符合 ASCENDE-RT 试验的纳入标准（中/高风险前列腺癌，不包括前列腺特异性抗原 >40 或肿瘤分期 T3b/T4 的患者）。 Mantel Haenszel 测试用于调查研究期间使用的放射方式类型的趋势。结果：确定了 156,411 名患者的队列。其中，103,188 名男性 (66%) 单独接受外照射放射治疗 (EBRT)，31,129 名男性 (20%) 单独接受近距离放射治疗，22,094 名男性 (14%) 接受 EBRT 加近距离放射治疗。从 2004 年到 2012 年，学术中心和非学术中心的 EBRT 加近距离放射治疗的利用率均显着下降，学术中心从 15% 下降到 8%，非学术中心从 19% 下降到 11%（趋势的 p 值）
PURPOSE: The Canadian Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy (ASCENDE-RT) randomized trial showed that brachytherapy boost reduces recurrence by 50% compared to dose-escalated radiation. We examined how men with identical inclusion criteria to the ASCENDE-RT trial were being treated in the United States.METHODS AND MATERIALS: We used the National Cancer Database to identify prostate cancer patients treated with radiation from 2004 through 2012 who met the inclusion criteria of the ASCENDE-RT trial (intermediate-/high-risk prostate cancer, excluding patients with prostate specific antigen >40 or tumor stage T3b/T4). The Mantel Haenszel test was used to investigate the trend for type of radiation modality used over the study period.RESULTS: A cohort of 156,411 patients was identified. Of those, 103,188 men (66%) were treated with external beam radiation therapy (EBRT) alone, 31,129 (20%) with brachytherapy alone, and 22,094 (14%) with EBRT plus brachytherapy. EBRT plus a brachytherapy boost demonstrated a significant decrease in utilization from 2004 to 2012 in both academic and nonacademic centers, declining from 15% to 8% in academic centers and from 19% to 11% in nonacademic centers (p-Value for trend