External Beam Radiation Therapy With or Without Brachytherapy Boost in Men With Very-High-Risk Prostate Cancer: A Large Multicenter International Consortium Analysis

Sagar A. Patel; Ting Martin Ma; Jessica K. Wong; Bradley J. Stish; Robert T. Dess; Avinash Pilar; Chandana Reddy; Trude B. Wedde; Wolfgang A. Lilleby; Ryan Fiano; Gregory S. Merrick; Richard G. Stock; D. Jeffrey Demanes; Brian J. Moran; Phuoc T. Tran; Daniel J. Krauss; Eyad I. Abu-Isa; Thomas M. Pisansky; C. Richard Choo; Daniel Y. Song; Stephen Greco; Curtiland Deville; Theodore L. DeWeese; Derya Tilki; Jay P. Ciezki; R. Jeffrey Karnes; Nicholas G. Nickols; Matthew B. Rettig; Felix Y. Feng; Alejandro Berlin; Jonathan D. Tward; Brian J. Davis; Robert E. Reiter; Paul C. Boutros; Tahmineh Romero; Eric M. Horwitz; Rahul D. Tendulkar; Michael L. Steinberg; Daniel E. Spratt; Michael Xiang; Amar U. Kishan

doi:10.1016/j.ijrobp.2022.09.075

External Beam Radiation Therapy With or Without Brachytherapy Boost in Men With Very-High-Risk Prostate Cancer: A Large Multicenter International Consortium Analysis

Sagar A. Patel, Ting Martin Ma, Jessica K. Wong, Bradley J. Stish, Robert T. Dess, Avinash Pilar, Chandana Reddy, Trude B. Wedde, Wolfgang A. Lilleby, Ryan Fiano, Gregory S. Merrick, Richard G. Stock, D. Jeffrey Demanes, Brian J. Moran, Phuoc T. Tran, Daniel J. Krauss, Eyad I. Abu-Isa, Thomas M. Pisansky, C. Richard Choo, Daniel Y. SongStephen Greco, Curtiland Deville, Theodore L. DeWeese, Derya Tilki, Jay P. Ciezki, R. Jeffrey Karnes, Nicholas G. Nickols, Matthew B. Rettig, Felix Y. Feng, Alejandro Berlin, Jonathan D. Tward, Brian J. Davis, Robert E. Reiter, Paul C. Boutros, Tahmineh Romero, Eric M. Horwitz, Rahul D. Tendulkar, Michael L. Steinberg, Daniel E. Spratt, Michael Xiang, Amar U. Kishan

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: Very-high-risk (VHR) prostate cancer (PC) is an aggressive subgroup with high risk of distant disease progression. Systemic treatment intensification with abiraterone or docetaxel reduces PC-specific mortality (PCSM) and distant metastasis (DM) in men receiving external beam radiation therapy (EBRT) with androgen deprivation therapy (ADT). Whether prostate-directed treatment intensification with the addition of brachytherapy (BT) boost to EBRT with ADT improves outcomes in this group is unclear. Methods and Materials: This cohort study from 16 centers across 4 countries included men with VHR PC treated with either dose-escalated EBRT with ≥24 months of ADT or EBRT + BT boost with ≥12 months of ADT. VHR was defined by National Comprehensive Cancer Network (NCCN) criteria (clinical T3b-4, primary Gleason pattern 5, or ≥2 NCCN high-risk features), and results were corroborated in a subgroup of men who met Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trials inclusion criteria (≥2 of the following: clinical T3-4, Gleason 8-10, or PSA ≥40 ng/mL). PCSM and DM between EBRT and EBRT + BT were compared using inverse probability of treatment weight-adjusted Fine-Gray competing risk regression. Results: Among the entire cohort, 270 underwent EBRT and 101 EBRT + BT. After a median follow-up of 7.8 years, 6.7% and 5.9% of men died of PC and 16.3% and 9.9% had DM after EBRT and EBRT + BT, respectively. There was no significant difference in PCSM (sHR, 1.47 [95% CI, 0.57-3.75]; P = .42) or DM (sHR, 0.72, [95% CI, 0.30-1.71]; P = .45) between EBRT + BT and EBRT. Results were similar within the STAMPEDE-defined VHR subgroup (PCSM: sHR, 1.67 [95% CI, 0.48-5.81]; P = .42; DM: sHR, 0.56 [95% CI, 0.15-2.04]; P = .38). Conclusions: In this VHR PC cohort, no difference in clinically meaningful outcomes was observed between EBRT alone with ≥24 months of ADT compared with EBRT + BT with ≥12 months of ADT. Comparative analyses in men treated with intensified systemic therapy are warranted.

Original language	English (US)
Pages (from-to)	645-653
Number of pages	9
Journal	International Journal of Radiation Oncology Biology Physics
Volume	115
Issue number	3
DOIs	https://doi.org/10.1016/j.ijrobp.2022.09.075
State	Published - Mar 1 2023

ASJC Scopus subject areas

Radiation
Oncology
Radiology Nuclear Medicine and imaging
Cancer Research

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10.1016/j.ijrobp.2022.09.075

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Patel, S. A., Ma, T. M., Wong, J. K., Stish, B. J., Dess, R. T., Pilar, A., Reddy, C., Wedde, T. B., Lilleby, W. A., Fiano, R., Merrick, G. S., Stock, R. G., Demanes, D. J., Moran, B. J., Tran, P. T., Krauss, D. J., Abu-Isa, E. I., Pisansky, T. M., Choo, C. R., ... Kishan, A. U. (2023). External Beam Radiation Therapy With or Without Brachytherapy Boost in Men With Very-High-Risk Prostate Cancer: A Large Multicenter International Consortium Analysis. International Journal of Radiation Oncology Biology Physics, 115(3), 645-653. https://doi.org/10.1016/j.ijrobp.2022.09.075

External Beam Radiation Therapy With or Without Brachytherapy Boost in Men With Very-High-Risk Prostate Cancer: A Large Multicenter International Consortium Analysis. / Patel, Sagar A.; Ma, Ting Martin; Wong, Jessica K. et al.
In: International Journal of Radiation Oncology Biology Physics, Vol. 115, No. 3, 01.03.2023, p. 645-653.

Research output: Contribution to journal › Article › peer-review

Patel, SA, Ma, TM, Wong, JK, Stish, BJ, Dess, RT, Pilar, A, Reddy, C, Wedde, TB, Lilleby, WA, Fiano, R, Merrick, GS, Stock, RG, Demanes, DJ, Moran, BJ, Tran, PT, Krauss, DJ, Abu-Isa, EI, Pisansky, TM, Choo, CR, Song, DY, Greco, S, Deville, C, DeWeese, TL, Tilki, D, Ciezki, JP, Karnes, RJ, Nickols, NG, Rettig, MB, Feng, FY, Berlin, A, Tward, JD, Davis, BJ, Reiter, RE, Boutros, PC, Romero, T, Horwitz, EM, Tendulkar, RD, Steinberg, ML, Spratt, DE, Xiang, M & Kishan, AU 2023, 'External Beam Radiation Therapy With or Without Brachytherapy Boost in Men With Very-High-Risk Prostate Cancer: A Large Multicenter International Consortium Analysis', International Journal of Radiation Oncology Biology Physics, vol. 115, no. 3, pp. 645-653. https://doi.org/10.1016/j.ijrobp.2022.09.075

@article{02c4a1073eda4ebc84512645b1d69f8f,

title = "External Beam Radiation Therapy With or Without Brachytherapy Boost in Men With Very-High-Risk Prostate Cancer: A Large Multicenter International Consortium Analysis",

abstract = "Purpose: Very-high-risk (VHR) prostate cancer (PC) is an aggressive subgroup with high risk of distant disease progression. Systemic treatment intensification with abiraterone or docetaxel reduces PC-specific mortality (PCSM) and distant metastasis (DM) in men receiving external beam radiation therapy (EBRT) with androgen deprivation therapy (ADT). Whether prostate-directed treatment intensification with the addition of brachytherapy (BT) boost to EBRT with ADT improves outcomes in this group is unclear. Methods and Materials: This cohort study from 16 centers across 4 countries included men with VHR PC treated with either dose-escalated EBRT with ≥24 months of ADT or EBRT + BT boost with ≥12 months of ADT. VHR was defined by National Comprehensive Cancer Network (NCCN) criteria (clinical T3b-4, primary Gleason pattern 5, or ≥2 NCCN high-risk features), and results were corroborated in a subgroup of men who met Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trials inclusion criteria (≥2 of the following: clinical T3-4, Gleason 8-10, or PSA ≥40 ng/mL). PCSM and DM between EBRT and EBRT + BT were compared using inverse probability of treatment weight-adjusted Fine-Gray competing risk regression. Results: Among the entire cohort, 270 underwent EBRT and 101 EBRT + BT. After a median follow-up of 7.8 years, 6.7% and 5.9% of men died of PC and 16.3% and 9.9% had DM after EBRT and EBRT + BT, respectively. There was no significant difference in PCSM (sHR, 1.47 [95% CI, 0.57-3.75]; P = .42) or DM (sHR, 0.72, [95% CI, 0.30-1.71]; P = .45) between EBRT + BT and EBRT. Results were similar within the STAMPEDE-defined VHR subgroup (PCSM: sHR, 1.67 [95% CI, 0.48-5.81]; P = .42; DM: sHR, 0.56 [95% CI, 0.15-2.04]; P = .38). Conclusions: In this VHR PC cohort, no difference in clinically meaningful outcomes was observed between EBRT alone with ≥24 months of ADT compared with EBRT + BT with ≥12 months of ADT. Comparative analyses in men treated with intensified systemic therapy are warranted.",

author = "Patel, {Sagar A.} and Ma, {Ting Martin} and Wong, {Jessica K.} and Stish, {Bradley J.} and Dess, {Robert T.} and Avinash Pilar and Chandana Reddy and Wedde, {Trude B.} and Lilleby, {Wolfgang A.} and Ryan Fiano and Merrick, {Gregory S.} and Stock, {Richard G.} and Demanes, {D. Jeffrey} and Moran, {Brian J.} and Tran, {Phuoc T.} and Krauss, {Daniel J.} and Abu-Isa, {Eyad I.} and Pisansky, {Thomas M.} and Choo, {C. Richard} and Song, {Daniel Y.} and Stephen Greco and Curtiland Deville and DeWeese, {Theodore L.} and Derya Tilki and Ciezki, {Jay P.} and Karnes, {R. Jeffrey} and Nickols, {Nicholas G.} and Rettig, {Matthew B.} and Feng, {Felix Y.} and Alejandro Berlin and Tward, {Jonathan D.} and Davis, {Brian J.} and Reiter, {Robert E.} and Boutros, {Paul C.} and Tahmineh Romero and Horwitz, {Eric M.} and Tendulkar, {Rahul D.} and Steinberg, {Michael L.} and Spratt, {Daniel E.} and Michael Xiang and Kishan, {Amar U.}",

note = "Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

year = "2023",

month = mar,

day = "1",

doi = "10.1016/j.ijrobp.2022.09.075",

language = "English (US)",

volume = "115",

pages = "645--653",

journal = "International Journal of Radiation Oncology Biology Physics",

issn = "0360-3016",

publisher = "Elsevier Inc.",

number = "3",

}

TY - JOUR

T1 - External Beam Radiation Therapy With or Without Brachytherapy Boost in Men With Very-High-Risk Prostate Cancer

T2 - A Large Multicenter International Consortium Analysis

AU - Patel, Sagar A.

AU - Ma, Ting Martin

AU - Wong, Jessica K.

AU - Stish, Bradley J.

AU - Dess, Robert T.

AU - Pilar, Avinash

AU - Reddy, Chandana

AU - Wedde, Trude B.

AU - Lilleby, Wolfgang A.

AU - Fiano, Ryan

AU - Merrick, Gregory S.

AU - Stock, Richard G.

AU - Demanes, D. Jeffrey

AU - Moran, Brian J.

AU - Tran, Phuoc T.

AU - Krauss, Daniel J.

AU - Abu-Isa, Eyad I.

AU - Pisansky, Thomas M.

AU - Choo, C. Richard

AU - Song, Daniel Y.

AU - Greco, Stephen

AU - Deville, Curtiland

AU - DeWeese, Theodore L.

AU - Tilki, Derya

AU - Ciezki, Jay P.

AU - Karnes, R. Jeffrey

AU - Nickols, Nicholas G.

AU - Rettig, Matthew B.

AU - Feng, Felix Y.

AU - Berlin, Alejandro

AU - Tward, Jonathan D.

AU - Davis, Brian J.

AU - Reiter, Robert E.

AU - Boutros, Paul C.

AU - Romero, Tahmineh

AU - Horwitz, Eric M.

AU - Tendulkar, Rahul D.

AU - Steinberg, Michael L.

AU - Spratt, Daniel E.

AU - Xiang, Michael

AU - Kishan, Amar U.

PY - 2023/3/1

Y1 - 2023/3/1

N2 - Purpose: Very-high-risk (VHR) prostate cancer (PC) is an aggressive subgroup with high risk of distant disease progression. Systemic treatment intensification with abiraterone or docetaxel reduces PC-specific mortality (PCSM) and distant metastasis (DM) in men receiving external beam radiation therapy (EBRT) with androgen deprivation therapy (ADT). Whether prostate-directed treatment intensification with the addition of brachytherapy (BT) boost to EBRT with ADT improves outcomes in this group is unclear. Methods and Materials: This cohort study from 16 centers across 4 countries included men with VHR PC treated with either dose-escalated EBRT with ≥24 months of ADT or EBRT + BT boost with ≥12 months of ADT. VHR was defined by National Comprehensive Cancer Network (NCCN) criteria (clinical T3b-4, primary Gleason pattern 5, or ≥2 NCCN high-risk features), and results were corroborated in a subgroup of men who met Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trials inclusion criteria (≥2 of the following: clinical T3-4, Gleason 8-10, or PSA ≥40 ng/mL). PCSM and DM between EBRT and EBRT + BT were compared using inverse probability of treatment weight-adjusted Fine-Gray competing risk regression. Results: Among the entire cohort, 270 underwent EBRT and 101 EBRT + BT. After a median follow-up of 7.8 years, 6.7% and 5.9% of men died of PC and 16.3% and 9.9% had DM after EBRT and EBRT + BT, respectively. There was no significant difference in PCSM (sHR, 1.47 [95% CI, 0.57-3.75]; P = .42) or DM (sHR, 0.72, [95% CI, 0.30-1.71]; P = .45) between EBRT + BT and EBRT. Results were similar within the STAMPEDE-defined VHR subgroup (PCSM: sHR, 1.67 [95% CI, 0.48-5.81]; P = .42; DM: sHR, 0.56 [95% CI, 0.15-2.04]; P = .38). Conclusions: In this VHR PC cohort, no difference in clinically meaningful outcomes was observed between EBRT alone with ≥24 months of ADT compared with EBRT + BT with ≥12 months of ADT. Comparative analyses in men treated with intensified systemic therapy are warranted.

AB - Purpose: Very-high-risk (VHR) prostate cancer (PC) is an aggressive subgroup with high risk of distant disease progression. Systemic treatment intensification with abiraterone or docetaxel reduces PC-specific mortality (PCSM) and distant metastasis (DM) in men receiving external beam radiation therapy (EBRT) with androgen deprivation therapy (ADT). Whether prostate-directed treatment intensification with the addition of brachytherapy (BT) boost to EBRT with ADT improves outcomes in this group is unclear. Methods and Materials: This cohort study from 16 centers across 4 countries included men with VHR PC treated with either dose-escalated EBRT with ≥24 months of ADT or EBRT + BT boost with ≥12 months of ADT. VHR was defined by National Comprehensive Cancer Network (NCCN) criteria (clinical T3b-4, primary Gleason pattern 5, or ≥2 NCCN high-risk features), and results were corroborated in a subgroup of men who met Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trials inclusion criteria (≥2 of the following: clinical T3-4, Gleason 8-10, or PSA ≥40 ng/mL). PCSM and DM between EBRT and EBRT + BT were compared using inverse probability of treatment weight-adjusted Fine-Gray competing risk regression. Results: Among the entire cohort, 270 underwent EBRT and 101 EBRT + BT. After a median follow-up of 7.8 years, 6.7% and 5.9% of men died of PC and 16.3% and 9.9% had DM after EBRT and EBRT + BT, respectively. There was no significant difference in PCSM (sHR, 1.47 [95% CI, 0.57-3.75]; P = .42) or DM (sHR, 0.72, [95% CI, 0.30-1.71]; P = .45) between EBRT + BT and EBRT. Results were similar within the STAMPEDE-defined VHR subgroup (PCSM: sHR, 1.67 [95% CI, 0.48-5.81]; P = .42; DM: sHR, 0.56 [95% CI, 0.15-2.04]; P = .38). Conclusions: In this VHR PC cohort, no difference in clinically meaningful outcomes was observed between EBRT alone with ≥24 months of ADT compared with EBRT + BT with ≥12 months of ADT. Comparative analyses in men treated with intensified systemic therapy are warranted.

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DO - 10.1016/j.ijrobp.2022.09.075

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SN - 0360-3016

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JO - International Journal of Radiation Oncology Biology Physics

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ER -

External Beam Radiation Therapy With or Without Brachytherapy Boost in Men With Very-High-Risk Prostate Cancer: A Large Multicenter International Consortium Analysis

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