- Email: [email protected]
Patterns of Postprostatectomy Adjuvant Radiation Therapy Utilization for Nonmetastatic Prostate Cancer in a Large, National Cohort
Poster Viewing E245
Volume 96 Number 2S Supplement 2016 proton beam therapy (PBT) compared to alternative forms of EBRT for localized prostate cancer. Materials/Methods: The National Cancer Data Base (NCDB) was queried for men with localized (N0, M0) prostate cancer diagnosed between 2004 and 2013, treated with EBRT, with available data on EBRT modality (photon vs. PBT). Binary multiple logistic regression identified variables associated with EBRT modality. Results: In total 143,702 patients were evaluated with relatively few men receiving PBT [5,709 (4.0%)]. Significant differences in patient and clinical characteristics were identified between those men treated with PBT compared to photons (odds ratio; 95% confidence interval). Patients treated with PBT were generally younger (OR 0.73; 0.67-0.82), NCCN low-risk compared to intermediate (0.71; 0.65-0.78) or high (0.44; 0.380.50) risk, white vs. black race (0.66; 0.58-0.77), and with less comorbidity (Charlson-Deyo 0 vs. 2+; 0.70; 0.50-0.98). Patients treated with PBT were also more likely to travel >100 miles to the treatment facility (202; 182-224), live in higher income counties (1.55; 1.36-1.78), and live in metropolitan areas compared to urban (0.21; 0.18-0.23) or rural (0.14; 0.10-0.19) areas. Annual PBT utilization during the study time period significantly increased in both total number and percentage of EBRT over time (2.7% to 5.6%; P<0.001). PBT utilization increased most in men classified as NCCN low-risk (4% to 10.2%). The southern region showed the largest PBT utilization increase over time (0% to 44% of all PBT). Conclusion: PBT for men with localized prostate cancer significantly increased in the United States from 2004-2013. Men with NCCN lowrisk prostate cancer and treatments in the southern region primarily accounted for the national increase in PBT utilization. Multiple demographic and prognostic differences between those men treated with photons and PBT were identified. These data raise concerns regarding access to advanced technologies and reliability of non-randomized treatment outcome data comparing EBRT modalities for localized prostate cancer. Author Disclosure: A. Amini: None. B.D. Kavanagh: None. D. Raben: None. E. Crawford: None. T.W. Flaig: None. E.R. Kessler: None. E.T. Lam: None. P. Maroni: None. T.J. Pugh: None.
received HT. The median RT dose increased from 6660 cGy in the period from 2004-2008 to 6840 cGy in the period from 2009-2012. RT doses of <6600cGy were used more frequently in 2004 (34.6%) and then declined over time to 10.2% by 2012 (P<0.001). Concurrently, RT doses of 7000cGy were utilized 20.0% of the time in 2004 and increased over time to 40.8% by 2012 (P<0.001). The escalation of RT doses paralleled a rapid increase in the usage of intensity modulated radiation therapy (IMRT) from 20.6% of patients in 2004 to 68.9% in 2012. There were no differences in RT dose based on margin status (P Z 0.29). The relative proportion of men receiving HT remained relatively consistent throughout the study period, ranging between 30.1%-36.3%. Conclusion: The vast majority of men (90.8%) with pT3 or pT2 with positive margins do not receive adjuvant RT. For those who do receive RT, IMRT use has rapidly increased since 2004 and is now utilized in almost 70% of patients. Coincident with the increase in IMRT utilization, there has been a modest escalation in RT dose leading to the routine adoption of RT doses 6840cGy. HT is used in about one third of patients who are receiving RT and its usage has remained relatively stable over time. Author Disclosure: A.T. Wong: None. D. Schwartz: None. A. Lee: None. J. Safdieh: None. V. Osborn: None. D. Schreiber: None.
2597
Purpose/Objective(s): Multiparametric MRI (mpMRI) has improved detection and risk stratification of men with newly diagnosed prostate cancer. mpMRI has recently been explored in the setting of biochemical recurrence after external beam radiation therapy and High Dose Rate brachytherapy. However, mpMRI is not routinely performed in the setting of biochemical relapse after Low Dose Rate (LDR) brachytherapy because of concern for seed-induced MRI artifact. Herein, we report the first series of post-LDR brachytherapy mpMRI and confirmatory biopsy in the setting of PSA relapse. Materials/Methods: All patients who received LDR brachytherapy as a component of therapy and were referred to our institution for mpMRI following PSA relapse were analyzed (2011-present). mpMRI consisted of endorectal coil T2 weighted imaging (T2W), dynamic contrast enhanced (DCE) imaging, and diffusion weighted imaging (DWI) sequences with apparent diffusion coefficient (ADC) maps. Lesions were categorized as suspicious by a prostate-dedicated radiologist based on detection in each sequence. Biopsy was performed in patients with no evidence of metastases. Biopsy-proven lesions without unilateral mpMRI findings were considered false negative identifications by mpMRI. Sensitivity (SN) and positive predictive value (PPV) of mpMRI in detecting biopsy-confirmed lesions was determined. Results: 20 patients who developed recurrence post-brachytherapy (Phoenix Criteria: n Z 19, rapid PSA rise: n Z 1) were included. The mean PSA at the time of mpMRI was 6.42 ng/ml. Pre-implant Gleason score was 6 in 12 patients and >6 in 8 patients. The median time from implant to recurrence was 62 months. Prostate biopsy was performed in 17 patients (n Z 3 excluded due to metastases). mpMRI detected at least one suspicious prostate lesion in 15/17 patients. A total of 25 lesions were identified (0-4 per patient), 16 of which were confirmed pathologically in
Patterns of Postprostatectomy Adjuvant Radiation Therapy Utilization for Nonmetastatic Prostate Cancer in a Large, National Cohort A.T. Wong,1,2 D. Schwartz,1,2 A. Lee,1,2 J. Safdieh,1,2 V. Osborn,1,2 and D. Schreiber1,2; 1Veterans Affairs NY Harbor Healthcare System, Brooklyn, NY, 2SUNY Downstate Medical Center, Brooklyn, NY Purpose/Objective(s): The addition of postprostatectomy adjuvant radiation therapy (RT) has been demonstrated by several randomized trials to improve oncologic outcomes for patients with adverse pathologic features including involved surgical margins, extracapsular extension, or seminal vesicle invasion. The purpose of this study was to analyze the contemporary patterns of care regarding adjuvant RT usage for patients with pT3 disease or positive margins after prostatectomy. Materials/Methods: Men who were diagnosed with nonmetastatic prostate cancer and underwent prostatectomy between 2004 and 2012 were abstracted from the National Cancer Data Base. Only those with stage pT3-4Nx-0M0 or stage pT2cNx-0M0 with positive margins were included. Data regarding adjuvant RT utilization and RT dose were collected. Patients were identified as either having not received RT or having received external beam RT to the pelvis/prostate region to a dose between 59407560cGy. Delivery of hormonal therapy (HT) was also identified. Descriptive statistics were used to determine adjuvant radiation utilization as well as patterns of care regarding radiation dose and hormone usage and were compared via the Pearson Chi Square test. Results: There were 134,086 patients included in this study, of which 12,285 (9.2%) received adjuvant radiation. HT was offered to a total of 9,061 men (6.8%). Of those receiving adjuvant RT, 4,073 (33.1%) also
2598 Assessment of Multiparametric Magnetic Resonance Imaging for the Detection of Local Recurrence After Low-Dose-Rate Brachytherapy L. Valle,1 M.D. Greer,2 A. Muthigi,3 A.V. Krauze,4 A. Kaushal,1 D. Su,3 P.A. Pinto,5 B. Wood,6 M.J. Merino,7 H. Ning,4 B. Arora,1 T. CooleyZgela,1 P. Choyke,8 B. Turkbey,2 and D.E. Citrin1; 1Radiation Oncology Branch, NCI, Bethesda, MD, 2Molecular Imaging Program, NCI, NIH, Bethesda, MD, 3Urologic Oncology Branch, NCI, Bethesda, MD, 4 National Cancer Institute, National Institutes of Health, Bethesda, MD, 5 Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, 6NCI, Bethesda, MD, 7Laboratory of Pathology, NCI, NIH, Bethesda, MD, 8Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD
Volume 96 Number 2S Supplement 2016 proton beam therapy (PBT) compared to alternative forms of EBRT for localized prostate cancer. Materials/Methods: The National Cancer Data Base (NCDB) was queried for men with localized (N0, M0) prostate cancer diagnosed between 2004 and 2013, treated with EBRT, with available data on EBRT modality (photon vs. PBT). Binary multiple logistic regression identified variables associated with EBRT modality. Results: In total 143,702 patients were evaluated with relatively few men receiving PBT [5,709 (4.0%)]. Significant differences in patient and clinical characteristics were identified between those men treated with PBT compared to photons (odds ratio; 95% confidence interval). Patients treated with PBT were generally younger (OR 0.73; 0.67-0.82), NCCN low-risk compared to intermediate (0.71; 0.65-0.78) or high (0.44; 0.380.50) risk, white vs. black race (0.66; 0.58-0.77), and with less comorbidity (Charlson-Deyo 0 vs. 2+; 0.70; 0.50-0.98). Patients treated with PBT were also more likely to travel >100 miles to the treatment facility (202; 182-224), live in higher income counties (1.55; 1.36-1.78), and live in metropolitan areas compared to urban (0.21; 0.18-0.23) or rural (0.14; 0.10-0.19) areas. Annual PBT utilization during the study time period significantly increased in both total number and percentage of EBRT over time (2.7% to 5.6%; P<0.001). PBT utilization increased most in men classified as NCCN low-risk (4% to 10.2%). The southern region showed the largest PBT utilization increase over time (0% to 44% of all PBT). Conclusion: PBT for men with localized prostate cancer significantly increased in the United States from 2004-2013. Men with NCCN lowrisk prostate cancer and treatments in the southern region primarily accounted for the national increase in PBT utilization. Multiple demographic and prognostic differences between those men treated with photons and PBT were identified. These data raise concerns regarding access to advanced technologies and reliability of non-randomized treatment outcome data comparing EBRT modalities for localized prostate cancer. Author Disclosure: A. Amini: None. B.D. Kavanagh: None. D. Raben: None. E. Crawford: None. T.W. Flaig: None. E.R. Kessler: None. E.T. Lam: None. P. Maroni: None. T.J. Pugh: None.
received HT. The median RT dose increased from 6660 cGy in the period from 2004-2008 to 6840 cGy in the period from 2009-2012. RT doses of <6600cGy were used more frequently in 2004 (34.6%) and then declined over time to 10.2% by 2012 (P<0.001). Concurrently, RT doses of 7000cGy were utilized 20.0% of the time in 2004 and increased over time to 40.8% by 2012 (P<0.001). The escalation of RT doses paralleled a rapid increase in the usage of intensity modulated radiation therapy (IMRT) from 20.6% of patients in 2004 to 68.9% in 2012. There were no differences in RT dose based on margin status (P Z 0.29). The relative proportion of men receiving HT remained relatively consistent throughout the study period, ranging between 30.1%-36.3%. Conclusion: The vast majority of men (90.8%) with pT3 or pT2 with positive margins do not receive adjuvant RT. For those who do receive RT, IMRT use has rapidly increased since 2004 and is now utilized in almost 70% of patients. Coincident with the increase in IMRT utilization, there has been a modest escalation in RT dose leading to the routine adoption of RT doses 6840cGy. HT is used in about one third of patients who are receiving RT and its usage has remained relatively stable over time. Author Disclosure: A.T. Wong: None. D. Schwartz: None. A. Lee: None. J. Safdieh: None. V. Osborn: None. D. Schreiber: None.
2597
Purpose/Objective(s): Multiparametric MRI (mpMRI) has improved detection and risk stratification of men with newly diagnosed prostate cancer. mpMRI has recently been explored in the setting of biochemical recurrence after external beam radiation therapy and High Dose Rate brachytherapy. However, mpMRI is not routinely performed in the setting of biochemical relapse after Low Dose Rate (LDR) brachytherapy because of concern for seed-induced MRI artifact. Herein, we report the first series of post-LDR brachytherapy mpMRI and confirmatory biopsy in the setting of PSA relapse. Materials/Methods: All patients who received LDR brachytherapy as a component of therapy and were referred to our institution for mpMRI following PSA relapse were analyzed (2011-present). mpMRI consisted of endorectal coil T2 weighted imaging (T2W), dynamic contrast enhanced (DCE) imaging, and diffusion weighted imaging (DWI) sequences with apparent diffusion coefficient (ADC) maps. Lesions were categorized as suspicious by a prostate-dedicated radiologist based on detection in each sequence. Biopsy was performed in patients with no evidence of metastases. Biopsy-proven lesions without unilateral mpMRI findings were considered false negative identifications by mpMRI. Sensitivity (SN) and positive predictive value (PPV) of mpMRI in detecting biopsy-confirmed lesions was determined. Results: 20 patients who developed recurrence post-brachytherapy (Phoenix Criteria: n Z 19, rapid PSA rise: n Z 1) were included. The mean PSA at the time of mpMRI was 6.42 ng/ml. Pre-implant Gleason score was 6 in 12 patients and >6 in 8 patients. The median time from implant to recurrence was 62 months. Prostate biopsy was performed in 17 patients (n Z 3 excluded due to metastases). mpMRI detected at least one suspicious prostate lesion in 15/17 patients. A total of 25 lesions were identified (0-4 per patient), 16 of which were confirmed pathologically in
Patterns of Postprostatectomy Adjuvant Radiation Therapy Utilization for Nonmetastatic Prostate Cancer in a Large, National Cohort A.T. Wong,1,2 D. Schwartz,1,2 A. Lee,1,2 J. Safdieh,1,2 V. Osborn,1,2 and D. Schreiber1,2; 1Veterans Affairs NY Harbor Healthcare System, Brooklyn, NY, 2SUNY Downstate Medical Center, Brooklyn, NY Purpose/Objective(s): The addition of postprostatectomy adjuvant radiation therapy (RT) has been demonstrated by several randomized trials to improve oncologic outcomes for patients with adverse pathologic features including involved surgical margins, extracapsular extension, or seminal vesicle invasion. The purpose of this study was to analyze the contemporary patterns of care regarding adjuvant RT usage for patients with pT3 disease or positive margins after prostatectomy. Materials/Methods: Men who were diagnosed with nonmetastatic prostate cancer and underwent prostatectomy between 2004 and 2012 were abstracted from the National Cancer Data Base. Only those with stage pT3-4Nx-0M0 or stage pT2cNx-0M0 with positive margins were included. Data regarding adjuvant RT utilization and RT dose were collected. Patients were identified as either having not received RT or having received external beam RT to the pelvis/prostate region to a dose between 59407560cGy. Delivery of hormonal therapy (HT) was also identified. Descriptive statistics were used to determine adjuvant radiation utilization as well as patterns of care regarding radiation dose and hormone usage and were compared via the Pearson Chi Square test. Results: There were 134,086 patients included in this study, of which 12,285 (9.2%) received adjuvant radiation. HT was offered to a total of 9,061 men (6.8%). Of those receiving adjuvant RT, 4,073 (33.1%) also
2598 Assessment of Multiparametric Magnetic Resonance Imaging for the Detection of Local Recurrence After Low-Dose-Rate Brachytherapy L. Valle,1 M.D. Greer,2 A. Muthigi,3 A.V. Krauze,4 A. Kaushal,1 D. Su,3 P.A. Pinto,5 B. Wood,6 M.J. Merino,7 H. Ning,4 B. Arora,1 T. CooleyZgela,1 P. Choyke,8 B. Turkbey,2 and D.E. Citrin1; 1Radiation Oncology Branch, NCI, Bethesda, MD, 2Molecular Imaging Program, NCI, NIH, Bethesda, MD, 3Urologic Oncology Branch, NCI, Bethesda, MD, 4 National Cancer Institute, National Institutes of Health, Bethesda, MD, 5 Urologic Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, 6NCI, Bethesda, MD, 7Laboratory of Pathology, NCI, NIH, Bethesda, MD, 8Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD