Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes, and complications
Background: We aimed to illustrate national trends of post-radical prostatectomy (RP) radiotherapy (RT) and compare outcomes and toxicities in patients receiving eRT versus observation with or without late radiotherapy (lRT). Methods: Utilizing the Surveillance, Epidemiology, and End Results (SEER)-...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | Prostate International |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2287888220300726 |
| _version_ | 1797764839625457664 |
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| author | Young Suk Kwon Wei Wang Arnav Srivastava Thomas L. Jang Eric A. Singer Rahul R. Parikh Wun-Jae Kim Isaac Yi Kim |
| author_facet | Young Suk Kwon Wei Wang Arnav Srivastava Thomas L. Jang Eric A. Singer Rahul R. Parikh Wun-Jae Kim Isaac Yi Kim |
| author_sort | Young Suk Kwon |
| collection | DOAJ |
| description | Background: We aimed to illustrate national trends of post-radical prostatectomy (RP) radiotherapy (RT) and compare outcomes and toxicities in patients receiving eRT versus observation with or without late radiotherapy (lRT). Methods: Utilizing the Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2001 to 2011, we identified 7557 patients with high-risk pathologic features after RP (≥pT3N0 and/or positive surgical margins). Our study cohort consisted of patients receiving RT within 6 months of surgery (eRT), those receiving RT after 6 months (lRT), and those never receiving RT (observation). Another subcohort, delayed RT (dRT), encompassed both lRT and observation. Trends of post-RP RT were compared using the Cochran–Armitage trend test. Cox regression models identified factors predictive of worse survival outcomes. Kaplan–Meier analyses compared the eRT and the dRT groups. Results: Among those with pathologically confirmed high-risk prostate cancer (PCa) after RP, 12.7% (n = 959), 13.2% (n = 1710), and 74.1% (n = 4888) underwent eRT, lRT, and observation without RT, respectively. Of these strategies, the proportion of men on observation without RT increased significantly over time (p = 0.004). The multivariable Cox regression model demonstrated similar outcomes between the eRT and the dRT groups. At a median follow-up of 5.9 years, five-year overall and cancer-specific survival outcomes were more favorable in the dRT group, when compared to the eRT group. Conclusions: A blanket adoption of the eRT in high-risk PCa based on clinical trials with limited follow-up may result in overtreatment of a significant number of men and expose them to unnecessary radiation toxicity. |
| first_indexed | 2024-03-12T20:01:29Z |
| format | Article |
| id | doaj.art-11e047a0cb084372a12abb657c9216bc |
| institution | Directory Open Access Journal |
| issn | 2287-8882 |
| language | English |
| last_indexed | 2024-03-12T20:01:29Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Prostate International |
| spelling | doaj.art-11e047a0cb084372a12abb657c9216bc2023-08-02T02:20:35ZengElsevierProstate International2287-88822021-06-01928289Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes, and complicationsYoung Suk Kwon0Wei Wang1Arnav Srivastava2Thomas L. Jang3Eric A. Singer4Rahul R. Parikh5Wun-Jae Kim6Isaac Yi Kim7Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USADepartment of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USARutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USASection of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, New Brunswick, New Jersey, USASection of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, New Brunswick, New Jersey, USADepartment of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, New Brunswick, New Jersey, USADepartment of Urology, Chungbuk National University College of Medicine, Cheongju, KoreaSection of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, New Brunswick, New Jersey, USA; Corresponding author. Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, 195 Little Albany Street, #4565, New Brunswick, NJ, 08903, USA.Background: We aimed to illustrate national trends of post-radical prostatectomy (RP) radiotherapy (RT) and compare outcomes and toxicities in patients receiving eRT versus observation with or without late radiotherapy (lRT). Methods: Utilizing the Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2001 to 2011, we identified 7557 patients with high-risk pathologic features after RP (≥pT3N0 and/or positive surgical margins). Our study cohort consisted of patients receiving RT within 6 months of surgery (eRT), those receiving RT after 6 months (lRT), and those never receiving RT (observation). Another subcohort, delayed RT (dRT), encompassed both lRT and observation. Trends of post-RP RT were compared using the Cochran–Armitage trend test. Cox regression models identified factors predictive of worse survival outcomes. Kaplan–Meier analyses compared the eRT and the dRT groups. Results: Among those with pathologically confirmed high-risk prostate cancer (PCa) after RP, 12.7% (n = 959), 13.2% (n = 1710), and 74.1% (n = 4888) underwent eRT, lRT, and observation without RT, respectively. Of these strategies, the proportion of men on observation without RT increased significantly over time (p = 0.004). The multivariable Cox regression model demonstrated similar outcomes between the eRT and the dRT groups. At a median follow-up of 5.9 years, five-year overall and cancer-specific survival outcomes were more favorable in the dRT group, when compared to the eRT group. Conclusions: A blanket adoption of the eRT in high-risk PCa based on clinical trials with limited follow-up may result in overtreatment of a significant number of men and expose them to unnecessary radiation toxicity.http://www.sciencedirect.com/science/article/pii/S2287888220300726Adjuvant radiotherapyProstate cancerRadical prostatectomyRadiotherapySalvage radiotherapy |
| spellingShingle | Young Suk Kwon Wei Wang Arnav Srivastava Thomas L. Jang Eric A. Singer Rahul R. Parikh Wun-Jae Kim Isaac Yi Kim Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes, and complications Prostate International Adjuvant radiotherapy Prostate cancer Radical prostatectomy Radiotherapy Salvage radiotherapy |
| title | Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes, and complications |
| title_full | Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes, and complications |
| title_fullStr | Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes, and complications |
| title_full_unstemmed | Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes, and complications |
| title_short | Observation with or without late radiotherapy is equivalent to early radiotherapy in high-risk prostate cancer after radical prostatectomy: A SEER-Medicare analysis on trends, survival outcomes, and complications |
| title_sort | observation with or without late radiotherapy is equivalent to early radiotherapy in high risk prostate cancer after radical prostatectomy a seer medicare analysis on trends survival outcomes and complications |
| topic | Adjuvant radiotherapy Prostate cancer Radical prostatectomy Radiotherapy Salvage radiotherapy |
| url | http://www.sciencedirect.com/science/article/pii/S2287888220300726 |
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