title: Whole-pelvis radiotherapy in combination with interstitial brachytherapy: does coverage of the pelvic lymph nodes improve treatment outcome in high-risk prostate cancer?
abstract: OBJECTIVE
  To compare biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) rates among high-risk prostate cancer patients treated with brachytherapy and supplemental external beam radiation (EBRT) using either a mini-pelvis (MP) or a whole-pelvis (WP) field.
  
  
  METHODS
  From May 1995 to October 2005, 186 high-risk prostate cancer patients were treated with brachytherapy and EBRT with or without androgen-deprivation therapy (ADT). High-risk prostate cancer was defined as a Gleason score of > or =8 and/or a prostate-specific antigen (PSA) concentration of > or =20 ng/ml.
  
  
  RESULTS
  With a median follow-up of 6.7 years, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 91.7% vs. 84.4% (p = 0.126), 95.5% vs. 92.6% (p = 0.515), and 79.5% vs. 67.1% (p = 0.721), respectively. Among those patients who received ADT, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 93.6% vs. 90.1% (p = 0.413), 94.2% vs. 96.0% (p = 0.927), and 73.7% vs. 70.2% (p = 0.030), respectively. Among those patients who did not receive ADT, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 82.4% vs. 75.0% (p = 0.639), 100% vs. 88% (p = 0.198), and 87.5% vs. 58.8% (p = 0.030), respectively. Based on multivariate analysis, none of the evaluated parameters predicted for CSS, while bPFS was best predicted by ADT and percent positive biopsy results. OS was best predicted by age and percent positive biopsy results.
  
  
  CONCLUSIONS
  For high-risk prostate cancer patients receiving brachytherapy, there is a nonsignificant trend toward improved bPFS, CSS, and OS rates when brachytherapy is given with WPRT. This trend is most apparent among ADT-naïve patients, for whom a significant improvement in OS was observed.
authors: Tacoma/Valley Radiation Oncology Centers, Tacoma, Washington, USA.
authors: Nathan
authors: N
authors: Bittner
authors: Gregory S
authors: GS
authors: Merrick
authors: Kent E
authors: KE
authors: Wallner
authors: Wayne M
authors: WM
authors: Butler
authors: Robert
authors: R
authors: Galbreath
authors: Edward
authors: E
authors: Adamovich
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D015182:Lymphatic Irradiation / Q000379:methods*; D008297:Male; D010388:Pelvis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000532:radiotherapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen