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

• Authors: Dian Wang, Medical College of Wisconsin; Alex Ho, American College of Radiology; Ann S Hamilton, University of Southern California; Xiao-Cheng Wu, Louisiana State University; Mary Lo, University of Southern California; Steven Fleming, University of Kentucky; Michael Goodman, Emory University; Trevor Thompson, Centers for Disease Control and Prevention; Jean Owen, American College of Radiology
• Journal Title: Radiation Oncology
• Volume: Volume 9, Number 47
• Publisher: BioMed Central | 2014-02-05
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1186/1748-717X-9-47
• Subjects: Health Sciences, Oncology; Biology, Radiation
• Keywords: Prostate cancer; Radiotherapy; Patterns of care study

Abstract

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.