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Impact of national guidelines on brachytherapy monotherapy practice patterns for prostate cancer
Author(s) -
Tseng Yolanda D.,
Paciorek Alan T.,
Martin Neil E.,
D'Amico Anthony V.,
Cooperberg Matthew R.,
Nguyen Paul L.
Publication year - 2013
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28492
Subject(s) - medicine , prostate cancer , brachytherapy , prostatectomy , androgen deprivation therapy , radiation therapy , cancer , odds ratio , logistic regression , confounding , external beam radiotherapy , gynecology , urology , prostate , relative risk , oncology , confidence interval
BACKGROUND In 1999 and 2000, 2 national guidelines recommended brachytherapy monotherapy (BT) primarily for treatment of low‐risk prostate cancer but not high‐risk prostate cancer. This study examined rates of BT use before and after publication of these guidelines, as compared with 4 other treatment options. METHODS From 1990 to 2011, 8128 men with localized prostate cancer (≤ T3cN0M0) were treated definitively within the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry with 1 of 5 primary treatments: BT, external beam radiotherapy (EBRT), EBRT with androgen deprivation therapy, EBRT+BT, or radical prostatectomy. Men were categorized into low‐, intermediate‐, and high‐risk groups based on the guidelines' risk‐group definitions. Within each risk group, logistic regression was used to estimate odds ratios (OR) comparing BT with other treatment options between the 1990‐1998 and 1999‐2011 periods, adjusting for age, disease characteristics, and clinic type. RESULTS In total, 1117 men received BT alone for low‐ (n = 658), intermediate‐ (n = 244), or high‐risk disease (n = 215). BT comprised 6.1% of all treatments in 1990‐1998 versus 16.6% in 1999‐2011 ( P < .01). The odds of BT use remained increased after adjusting for potential confounders (OR = 3.06; P < .001) and was seen among low‐ (OR = 4.52; P < .001), intermediate‐ (OR = 2.67; P < .001), and even high‐risk groups (OR = 2.11; P < .001). CONCLUSIONS National guidelines did not appear to influence practice patterns, as BT monotherapy use increased relative to other treatments from the 1990‐1998 to 1999‐2011 periods in unfavorable risk groups including men with high‐risk prostate cancer. Cancer 2014;120:824–832 . © 2013 American Cancer Society .