title: Comparison of three radiotherapy modalities on biochemical control and overall survival for the treatment of prostate cancer: a systematic review.
abstract: OBJECTIVE
  For the radiation treatment of prostate cancer high dose should be delivered for optimal biochemical control. Treatment can be given by dose-escalated external beam radiotherapy (EBRT) or external beam radiotherapy combined with a radioactive seed implantation (EBSeeds) or high-dose rate (HDR) brachytherapy (EBTI). Differences in outcome between the modalities were assessed by a systematic review.
  
  
  METHODS
  A systematic search was performed resulting in 40 articles to be used. Data were extracted on biochemical control and overall survival at 3, 5, and 8 years and other time points mentioned in the articles. Also known prognostic parameters were noted. Comparison of the modalities was done by a Weibull survival analysis and estimation of Hazard Ratio's (HR) was done with 95% confidence intervals (95% CIs).
  
  
  RESULTS
  The HR for biochemical recurrence was 1.40 (95% CI 1.31-1.51) for EBRT relative to EBTI, and was 1.37 (95% CI 1.26-1.49) for EBSeeds relative to EBTI. The HR for overall survival was 1.50 (95% CI 1.29-1.73) for EBRT relative to EBTI, and was 2.33 (95% CI 2.04-2.66) for EBSeeds relative to EBTI.
  
  
  CONCLUSIONS
  The combination of external beam radiotherapy and HDR brachytherapy results in a superior biochemical control and overall survival found in a systematic review on radiotherapy for prostate cancer.
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, The Netherlands. b.r.pieters@amc.uva.nl
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Pieters
authors.forename: Djuna Z
authors.initials: DZ
authors.lastname: de Back
authors.forename: Caro C E
authors.initials: CC
authors.lastname: Koning
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
mesh_terms: D001918:Brachytherapy; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D011471:Prostatic Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D011879:Radiotherapy Dosage