Under-utilisation of high-dose-rate brachytherapy boost in men with intermediate-high risk prostate cancer treated with external beam radiotherapy

作者：Ong Wee Loon; Evans Sue M.; Millar Jeremy L.

来源：Journal of Medical Imaging and Radiation Oncology, 2018, 62(2): 256-261.

DOI：10.1111/1754-9485.12699

• brachytherapy
• prostate cancer
• registry

IntroductionThe aim of this study was to evaluate the use of high-dose-rate brachytherapy (HDR-BT) boost with definitive external beam radiotherapy (EBRT) in prostate cancer (CaP) management.
MethodsThe study population comprised men with intermediate-high risk CaP captured in the population-based Prostate Cancer Outcome Registry Victoria (PCOR-Vic), treated with EBRT from January 2010 to December 2015. The primary outcome is the proportion of men who received HDR-BT boost. Multivariate logistic regressions were used to evaluate the effect of patient-, tumour- and treatment-factors on the likelihood of HDR-BT use. Medicare Benefit Schedule (MBS) data was accessed to evaluate the Australia-wide pattern of HDR-BT use.
ResultsOne thousand eight hundred and six patients were included in this study - 886 (49%) intermediate-risk, and 920 (51%) high-risk CaP patients. Overall, only 124 (7%) patients had EBRT+HDR-BT - 47 (5%) intermediate-risk and 77 (8%) high-risk CaP patients (P=0.01). There is higher proportion of patients who had HDR-BT in public institutions (7% public vs. 3% private, P=0.005) and in metropolitan centres (9% metropolitan vs. 2% regional, P<0.001). In multivariate analyses, older patients were less likely to have HDR-BT (OR=0.92; 95% CI=0.89-0.94, P<0.001), while patients with high-risk CaP (OR=1.8; 95% CI=1.3-2.7; P=0.002) treated in metropolitan centres (OR=5.0; 95% CI=2.6-9.8; P<0.001) and public institutions (OR=3.8; 95% CI=1.5-9.4; P=0.005) were more likely to have EBRT+HDR-BT. There was significant decline in numbers of HDR-BT performed throughout Australia, from 313 cases in 2010 to 125 cases in 2015.
ConclusionHigh-dose-rate brachytherapy is under-utilised with EBRT in this contemporary population-based cohort of Victorian men with CaP. The decline in HDR-BT use was also observed nationally.

• 出版日期2018-4