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Adjuvant radiotherapy after prostatectomy: have randomized clinical trials had any impact?

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

The objective was to evaluate if the release of randomized trials evaluating the impact of adjuvant radiotherapy after prostatectomy in high risk patients had any impact on national practice patterns in patients with at least two high risk features.

Methods

The SEER database was used to extract data for patients with a diagnosis of prostate adenocarcinoma from the years 2004–2010, and who underwent prostatectomy with pathologic features of both extracapsular extension (ECE) and positive margins. Adjuvant radiotherapy (ART) utilization was calculated on a yearly basis, and odds ratios were calculated for the likelihood of ART use by year compared to 2004.

Results

Between 2004 and 2010, 5,231 patients were identified who underwent prostatectomy with both ECE and positive margins, of which only 19 % received ART. ART utilization was 21, 20, 22, 20, 18, 18, and 15 % for the years 2004–2010, respectively. Odds ratios demonstrated that the likelihood of ART to be used compared to 2004 demonstrated a statistical decrease from 0.97 (95 % C.I. 0.76–1.25, p = 0.85) in 2005 to 0.67 (95 % C.I. 0.51–0.90, p < 0.01) in 2010. At the end of the study time period, patients with higher risk disease were more likely to receive ART, with differences noted in clinical T stage, pretreatment PSA, Gleason score, Gleason patterns, and D’Amico risk classification (largest p = 0.02).

Conclusion

The release of randomized controlled trials demonstrating clinical and survival benefits with ART use in high risk patients has failed to increase the utilization of ART, instead demonstrating decreased utilization. In light of recently published guidelines, future changes will be of interest.

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Acknowledgments

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Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Statement of informed consent was not applicable since the manuscript does not contain any patient data. This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of interest

Aaron Wagner, Amol Ghia, Dennis Shrieve, Kristine Kokeny, William Lowrance, and Jonathan Tward declare they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope, Rm 1570, Salt Lake City, UT, 84112, USA

    Aaron E. Wagner, Dennis C. Shrieve, Kristine E. Kokeny & Jonathan D. Tward

  2. Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Amol J. Ghia

  3. Division of Urology, Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake, UT, USA

    William T. Lowrance

Authors
  1. Aaron E. Wagner
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  2. Amol J. Ghia
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  3. Dennis C. Shrieve
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  4. Kristine E. Kokeny
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  5. William T. Lowrance
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  6. Jonathan D. Tward
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Corresponding author

Correspondence to Jonathan D. Tward.

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Wagner, A.E., Ghia, A.J., Shrieve, D.C. et al. Adjuvant radiotherapy after prostatectomy: have randomized clinical trials had any impact?. J Radiat Oncol 3, 387–394 (2014). https://doi.org/10.1007/s13566-014-0156-5

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  • DOI: https://doi.org/10.1007/s13566-014-0156-5

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