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

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Abstract

Introduction: The 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. Methods: The 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. Results: One 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. Conclusion: High-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.

Original languageEnglish
Pages (from-to)256-261
Number of pages6
JournalJournal of Medical Imaging and Radiation Oncology
Volume62
Issue number2
DOIs
Publication statusPublished - 1 Apr 2018

Keywords

  • brachytherapy
  • prostate cancer
  • registry

Cite this

@article{69747a8cb2334e8d98354ccbc13a0b55,
title = "Under-utilisation of high-dose-rate brachytherapy boost in men with intermediate-high risk prostate cancer treated with external beam radiotherapy",
abstract = "Introduction: The 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. Methods: The 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. Results: One 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. Conclusion: High-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.",
keywords = "brachytherapy, prostate cancer, registry",
author = "Ong, {Wee Loon} and Evans, {Sue M} and Millar, {Jeremy L}",
year = "2018",
month = "4",
day = "1",
doi = "10.1111/1754-9485.12699",
language = "English",
volume = "62",
pages = "256--261",
journal = "Journal of Medical Imaging and Radiation Oncology",
issn = "1754-9477",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Under-utilisation of high-dose-rate brachytherapy boost in men with intermediate-high risk prostate cancer treated with external beam radiotherapy

AU - Ong, Wee Loon

AU - Evans, Sue M

AU - Millar, Jeremy L

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Introduction: The 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. Methods: The 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. Results: One 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. Conclusion: High-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.

AB - Introduction: The 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. Methods: The 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. Results: One 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. Conclusion: High-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.

KW - brachytherapy

KW - prostate cancer

KW - registry

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U2 - 10.1111/1754-9485.12699

DO - 10.1111/1754-9485.12699

M3 - Article

VL - 62

SP - 256

EP - 261

JO - Journal of Medical Imaging and Radiation Oncology

JF - Journal of Medical Imaging and Radiation Oncology

SN - 1754-9477

IS - 2

ER -