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

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