ArticleBrachytherapy
Impact of locoregional treatment intensification in stampede high-risk M0 prostate cancer patients.
Article in Brachytherapy. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThis study evaluates the efficacy of locoregional treatment intensification with combined modality therapy (CMT) for STAMPEDE high-risk (SHR) nonmetastatic (M0) prostate cancer. We compare metastasis-free survival (MFS) and overall survival (OS) between external beam radiation therapy (EBRT) with androgen deprivation therapy (ADT), CMT with a brachytherapy boost, and up-front surgery. MATERIAL AND
methodsA retrospective cohort of 217 SHR patients from our institutional database was stratified by treatment modality: EBRT + ADT (n = 56), CMT (n = 61), and surgery (n = 100). Median ADT duration was 24 months for the EBRT + ADT group and 6 months for the CMT group. Primary outcomes were MFS and OS, analyzed using Cox proportional hazards regression and Fine-Gray competing risks models, adjusted for PSA, age, and Gleason group.
resultsCMT significantly improved adjusted MFS compared to EBRT + ADT (HR 0.41; p = 0.004). In contrast, up-front surgery did not significantly improve MFS over EBRT + ADT (HR 0.84; p = 0.471). Adjusted OS was also superior with CMT compared to EBRT + ADT (HR 1.98; p = 0.025). On subgroup analysis, the MFS benefit of CMT persisted for N0 patients but not for N1 patients. A key limitation is the retrospective, nonrandomized nature of the data. DISCUSSION AND
conclusionsLocoregional treatment intensification with CMT and de-intensified ADT offers significant oncologic benefits in men with SHR M0 prostate cancer, particularly in N0 patients. These findings support further investigation into combining brachytherapy and systemic therapy with de-intensified ADT in prospective trials.
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