Does brachytherapy boost improve survival outcomes in Gleason Grade Group 5 patients treated with external beam radiotherapy and androgen deprivation therapy? A systematic review and meta-analysis
Background: Localized Gleason Grade Group 5 (GG5) prostate cancer has a poor prognosis and is associated with a higher risk of treatment failure, metastases, and death. Treatment intensification with the addition of a brachytherapy (BT) boost to external beam radiation (EBRT) maximizes local control...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-01-01
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| Series: | Clinical and Translational Radiation Oncology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630822000945 |
| _version_ | 1811178935022518272 |
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| author | Terence Tang Stephanie Gulstene Eric McArthur Andrew Warner Gabriel Boldt Vikram Velker David D'Souza Glenn Bauman Lucas C. Mendez |
| author_facet | Terence Tang Stephanie Gulstene Eric McArthur Andrew Warner Gabriel Boldt Vikram Velker David D'Souza Glenn Bauman Lucas C. Mendez |
| author_sort | Terence Tang |
| collection | DOAJ |
| description | Background: Localized Gleason Grade Group 5 (GG5) prostate cancer has a poor prognosis and is associated with a higher risk of treatment failure, metastases, and death. Treatment intensification with the addition of a brachytherapy (BT) boost to external beam radiation (EBRT) maximizes local control, which may translate into improved survival outcomes. Methods: A systematic review and meta-analysis was performed to compare survival outcomes for Gleason GG5 patients treated with androgen deprivation therapy (ADT) and either EBRT or EBRT + BT. The MEDLINE (PubMed), EMBASE and Cochrane databases were searched to identify relevant studies. Survival probabilities for distant metastasis-free survival (DMFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were extracted and pooled to create a summary survival curve for each treatment modality, which were then compared at fixed points in time. An additional analysis was performed among studies directly comparing EBRT and EBRT + BT using a random-effects model. Results: Eight retrospective studies were selected for inclusion, representing a total of 1393 EBRT patients and 877 EBRT + BT patients. EBRT + BT was associated with higher DMFS starting at 6 years (86.8 % vs 78.8 %; p = 0.018) and extending out to 10 years (81.8 % vs 66.1 %; p < 0.001), with an overall hazard ratio of 0.53 (p = 0.02). There was no difference in PCSS or OS between treatment modalities. Differences in toxicity were not assessed. There was a wide range of heterogeneity between studies. Conclusion: The addition of BT boost is associated with improved long-term DMFS in Gleason GG5 prostate cancer, but its impact on PCSS and OS remains unclear. These results may be confounded by the heterogeneity across study populations with concern for a risk of bias. Therefore, prospective studies are necessary to further elucidate the survival advantage associated with BT boost, which must ultimately be weighed against the toxicity-related implications of this treatment strategy. |
| first_indexed | 2024-04-11T06:26:20Z |
| format | Article |
| id | doaj.art-77cbd8265c2043d6ab6cdb6977ec0eb7 |
| institution | Directory Open Access Journal |
| issn | 2405-6308 |
| language | English |
| last_indexed | 2024-04-11T06:26:20Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj.art-77cbd8265c2043d6ab6cdb6977ec0eb72022-12-22T04:40:21ZengElsevierClinical and Translational Radiation Oncology2405-63082023-01-01382127Does brachytherapy boost improve survival outcomes in Gleason Grade Group 5 patients treated with external beam radiotherapy and androgen deprivation therapy? A systematic review and meta-analysisTerence Tang0Stephanie Gulstene1Eric McArthur2Andrew Warner3Gabriel Boldt4Vikram Velker5David D'Souza6Glenn Bauman7Lucas C. Mendez8Department of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario N6A 5W9, CanadaDepartment of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario N6A 5W9, CanadaDepartment of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario N6A 5W9, CanadaDepartment of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario N6A 5W9, CanadaDepartment of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario N6A 5W9, CanadaDepartment of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario N6A 5W9, CanadaDepartment of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario N6A 5W9, CanadaDepartment of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario N6A 5W9, CanadaCorresponding author.; Department of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, Ontario N6A 5W9, CanadaBackground: Localized Gleason Grade Group 5 (GG5) prostate cancer has a poor prognosis and is associated with a higher risk of treatment failure, metastases, and death. Treatment intensification with the addition of a brachytherapy (BT) boost to external beam radiation (EBRT) maximizes local control, which may translate into improved survival outcomes. Methods: A systematic review and meta-analysis was performed to compare survival outcomes for Gleason GG5 patients treated with androgen deprivation therapy (ADT) and either EBRT or EBRT + BT. The MEDLINE (PubMed), EMBASE and Cochrane databases were searched to identify relevant studies. Survival probabilities for distant metastasis-free survival (DMFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were extracted and pooled to create a summary survival curve for each treatment modality, which were then compared at fixed points in time. An additional analysis was performed among studies directly comparing EBRT and EBRT + BT using a random-effects model. Results: Eight retrospective studies were selected for inclusion, representing a total of 1393 EBRT patients and 877 EBRT + BT patients. EBRT + BT was associated with higher DMFS starting at 6 years (86.8 % vs 78.8 %; p = 0.018) and extending out to 10 years (81.8 % vs 66.1 %; p < 0.001), with an overall hazard ratio of 0.53 (p = 0.02). There was no difference in PCSS or OS between treatment modalities. Differences in toxicity were not assessed. There was a wide range of heterogeneity between studies. Conclusion: The addition of BT boost is associated with improved long-term DMFS in Gleason GG5 prostate cancer, but its impact on PCSS and OS remains unclear. These results may be confounded by the heterogeneity across study populations with concern for a risk of bias. Therefore, prospective studies are necessary to further elucidate the survival advantage associated with BT boost, which must ultimately be weighed against the toxicity-related implications of this treatment strategy.http://www.sciencedirect.com/science/article/pii/S2405630822000945Prostate cancerGleason Grade Group 5External beam radiotherapyBrachytherapy boostSurvival outcome |
| spellingShingle | Terence Tang Stephanie Gulstene Eric McArthur Andrew Warner Gabriel Boldt Vikram Velker David D'Souza Glenn Bauman Lucas C. Mendez Does brachytherapy boost improve survival outcomes in Gleason Grade Group 5 patients treated with external beam radiotherapy and androgen deprivation therapy? A systematic review and meta-analysis Clinical and Translational Radiation Oncology Prostate cancer Gleason Grade Group 5 External beam radiotherapy Brachytherapy boost Survival outcome |
| title | Does brachytherapy boost improve survival outcomes in Gleason Grade Group 5 patients treated with external beam radiotherapy and androgen deprivation therapy? A systematic review and meta-analysis |
| title_full | Does brachytherapy boost improve survival outcomes in Gleason Grade Group 5 patients treated with external beam radiotherapy and androgen deprivation therapy? A systematic review and meta-analysis |
| title_fullStr | Does brachytherapy boost improve survival outcomes in Gleason Grade Group 5 patients treated with external beam radiotherapy and androgen deprivation therapy? A systematic review and meta-analysis |
| title_full_unstemmed | Does brachytherapy boost improve survival outcomes in Gleason Grade Group 5 patients treated with external beam radiotherapy and androgen deprivation therapy? A systematic review and meta-analysis |
| title_short | Does brachytherapy boost improve survival outcomes in Gleason Grade Group 5 patients treated with external beam radiotherapy and androgen deprivation therapy? A systematic review and meta-analysis |
| title_sort | does brachytherapy boost improve survival outcomes in gleason grade group 5 patients treated with external beam radiotherapy and androgen deprivation therapy a systematic review and meta analysis |
| topic | Prostate cancer Gleason Grade Group 5 External beam radiotherapy Brachytherapy boost Survival outcome |
| url | http://www.sciencedirect.com/science/article/pii/S2405630822000945 |
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