Overall Survival After Treatment of Localized Prostate Cancer With Proton Beam Therapy, External-Beam Photon Therapy, or Brachytherapy

• Authors: Yuan Liu, Emory University; Sagar A. Patel, Emory University; Ashesh B Jani, Emory University; Theresa Wicklin Gillespie, Emory University; Pretesh Patel, Emory University; Karen D Godette, Emory University; Bruce Hershatter, Emory University; Joseph W. Shelton, Emory University; Mark W. McDonald, Emory University
• Journal Title: Clin Genitourin Cancer.
• Volume: Volume 19, Number 3
• Publisher: Elsevier | 2021-06-01, Pages 255-266.e7
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.clgc.2020.08.009
• Subjects: Health Sciences, Oncology
• Keywords: Brachytherapy; Comparative effectiveness; External-beam radiation; Localized prostate cancer; Proton beam radiation

Abstract

With limited high-level evidence, we carried out a comparative effectiveness study for the effect of proton beam therapy (PBT) on overall survival compared to external-beam radiotherapy (EBRT) and brachytherapy (BT) among patients with localized prostate cancer using a national database. PBT was associated with a significant overall survival benefit compared to EBRT and had a similar performance as BT. Background: There are few comparative outcomes data regarding the therapeutic delivery of proton beam therapy (PBT) versus the more widely used photon-based external-beam radiation (EBRT) and brachytherapy (BT). We evaluated the impact of PBT on overall survival (OS) compared to EBRT or BT on patients with localized prostate cancer. Patients and Methods: The National Cancer Data Base (NCDB) was queried for 2004–2015. Men with clinical stage T1–3, N0, M0 prostate cancer treated with radiation, without surgery or chemotherapy, were included. OS, the primary clinical outcome, was fit by Cox proportional hazard model. Propensity score matching was implemented for covariate balance. Results: There were 276,880 eligible patients with a median follow-up of 80.9 months. A total of 4900 (1.8%) received PBT, while 158,111 (57.1%) received EBRT and 113,869 (41.1%) BT. Compared to EBRT and BT, PBT patients were younger and were less likely to be in the high-risk group. On multivariable analysis, compared to PBT, men had worse OS after EBRT (adjusted hazard ratio [HR] = 1.72; 95% confidence interval [CI], 1.51–1.96) or BT (adjusted HR = 1.38; 95% CI, 1.21–1.58). After propensity score matching, the OS benefit of PBT remained significant compared to EBRT (HR = 1.64; 95% CI, 1.32–2.04) but not BT (adjusted HR = 1.18; 95% CI, 0.93–1.48). The improvement in OS with PBT was most prominent in men ≤ 65 years old with low-risk disease compared to other subgroups (interaction P < .001). Conclusion: In this national data set, PBT was associated with a significant OS benefit compared to EBRT, and with outcomes similar to BT. These results remain to be validated by ongoing prospective trials.