Type and dose of radiotherapy used for initial treatment of non-metastatic prostate cancer

Radiation Oncology

Jean Owen³  Trevor Thompson⁴  Michael Goodman⁵  Steven Fleming¹  Mary Lo²  Xiao-Cheng Wu⁶  Ann S Hamilton²  Alex Ho³  Dian Wang⁷ 

[1] University of Kentucky College of Public Health, Lexington, KY, USA;Keck School of Medicine, University of Southern California, Los Angeles, CA, USA;Clinical Research Center, American College of Radiology, Philadelphia, PA, USA;Centers for Disease Control and Prevention, Atlanta, GA, USA;Department Epidemiology, Rollins School Public Health, Emory University, Atlanta, GA, USA;Louisiana Tumor Registry, LSU Health Science Center, New Orleans, LA, USA;Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI 53045, USA

关键词: Patterns of care study;    Radiotherapy;    Prostate cancer;   

Others  :  814804
DOI  :  10.1186/1748-717X-9-47

 received in 2013-10-11, accepted in 2014-01-29,  发布年份 2014

【 摘 要 】

Background

We sought to describe patterns of initial radiotherapy among non-metastatic prostate cancer (PC) patients by recurrence risk groups.

Methods

Medical records were abstracted for a sample of 9017 PC cases diagnosed in 2004 as a part of the Center for Disease Control and Prevention’s Prostate and Breast Patterns of Care Study in seven states. Non-metastatic PC cases are categorized as low-risk (LR), intermediate-risk (IR) or high-risk (HR) groups based on pretreatment PSA, tumor stage, and Gleason score per 2002 NCCN guidelines. Univariate and multivariate analyses were employed to determine factors associated with the type and dose of radiotherapy by the risk groups.

Results

Of the 9,017 patients, 3153 who received definitive radiotherapy either alone or in combination with hormone therapy (HT) were selected for in-depth analysis. Multivariate models showed that LR patients were more likely to receive seed implant brachytherapy (BT) than those in higher risk groups. Those in the IR group were most likely to receive external beam radiotherapy (EBRT) combined with BT or high-dose radiotherapy. Use of HT in combination with radiotherapy was more common in the IR and HR groups than for LR patients. Intensity modulated radiation treatment (IMRT) was used to treat 32.6% of PC patients treated with EBRT, with the majority (60.6%) treated with high-dose radiotherapy.

Conclusions

Radiotherapy types and dosage utilization varied by PC risk groups. Patients in IR were more likely than those in LR or HR to receive high-dose radiotherapy. IMRT was used in about one third of patients to deliver high-dose radiotherapy.

【 授权许可】

   
2014 Wang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Mohler JL: The 2010 NCCN clinical practice guidelines in oncology on prostate cancer. J Natl Compr Canc Netw 2010, 8(2):145.
• [2]Maria H, Simone JV (Eds): Enhancing Data systems to improve the quality of cancer care In National Cancer Policy Board, Institute Of Medicine and Commission On Life Sciences, National Research Council. National Academy Press 2000, 87-88.
• [3]Schymura MJ, Kahn AR, German RR, et al.: Factors associated with initial treatment and survival for clinically localized prostate cancer: results from the CDC-NPCR Patterns of Care Study (PoC1). BMC Cancer 2010, 10:152. doi: 10.1186/1471-2407-10-152 BioMed Central Full Text
• [4]Hamilton AS, Fleming ST, Wang D, Goodman M, Wu XC, Owen JB, Lo M, Ho A, Anderson RT, Thompson T: Clinical and demographic factors associated with receipt of guideline concordant initial therapy for localized prostate cancer. Am J Clin Oncol 2014. Jan 1. [Epub ahead of print]
• [5]National Comprehensive Cancer Network (NCCN): NCCN Clinical Practice Guidelines in Oncology. Prostate Cancer 2002. Version 1 PROS-1
• [6]Hultstrom D, Havener L (Eds): Standards for Cancer Registries Volume II: Data Standards and Data Dictionary. Eighth edition. Version 10.1. Springfield, IL: North American Association of Central Cancer Registries; 2003.
• [7]Hamilton AS, Wu XC, Lipscomb J, et al.: Regional, provider, and economic factors associated with the choice of active surveillance in the treatment of men with localized prostate Cancer. J Natl Cancer Inst Monogr 2012, 45:213-220.
• [8]German R, Wike J, Bauer K, et al.: Quality of cancer registry data: findings from CDC-NPCR’s breast and prostate cancer data quality and patterns of care study. J of Reg Mngt 2011, 38:75-86.
• [9]AJCC Cancer Staging manual 6th edition. Chicago, IL: Springer; 2002.
• [10]Piccirillo J, Creech C, Zequeira R, Anderson S, Johnson A: Inclusion of comorbidity into oncology data registries. J of Reg Mngt 1999, 26:66-70.
• [11]Piccirillo J, Costas I, Claybour P, Borah A, Grove L, Jeffe D: The measurement of comorbidity by cancer registries. J of Reg Mngt 2003, 30:8-14.
• [12]Piccirillo J, Tierney R, Costas I, Grove L, Spitznagel E: Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2006, 291:2441-2447.
• [13]Zelefsky MJ, Moughan J, Owen J, Zietman AL, Roach M 3rd, Hanks GE: Changing trends in national practice for external beam radiotherapy for clinically localized prostate cancer: 1999 Patterns of Care survey for prostate cancer. Int J Radiat Oncol Biol Phys 2004, 59(4):1053-1061.
• [14]Hamilton AS, Albertsen PC, Johnson TK, et al.: Trends in the treatment of localized prostate cancer using supplemented cancer registry data. BJU Int 2011, 107(4):576-584.
• [15]Zelefsky MJ, Lee WR, Zietman A, Khalid N, Crozier C, Owen J, Wilson JF: Evaluation of adherence to quality measures for prostate cancer in the United States: results from the quality research in radiation oncology (QRRO) survey. Pract Radiat Onc 2013, 3(1):2-8.
• [16]Li XA, Wang JZ, Jursinic PA, Lawton CA, Wang D: Dosimetric advantages of IMRT simultaneous integrated boost for high-risk prostate cancer. Int J Radiat Oncol Biol Phys 2005, 61(4):1251-1257.
• [17]Zietman AL, DeSilvo ML, Slater JD, et al.: Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: a randomized controlled trial. JAMA 2005, 294:1233-1239.
• [18]Bolla M, Gonzalez D, Warde P, et al.: Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med 1997, 337(5):295-300.
• [19]Lawton CA, Winter K, Murray K, et al.: Updated results of the phase III Radiation Therapy Oncology Group (RTOG) trial 85-31 evaluating the potential benefit of androgen suppression following standard radiation therapy for unfavorable prognosis carcinoma of the prostate. Int J Radiat Oncol Biol Phys 2001, 49(4):937-946.
• [20]D’Amico AV, Manola J, Loffredo M, Renshaw AA, DellaCroce A, Kantoff PW: 6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA 2004, 292(7):821-827.