PD34-04 IS ADJUVANT RADIATION THERAPY UNDER-UTILIZED IN HIGH-RISK POST-PROSTATECTOMY PATIENTS?

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II1 Apr 2014PD34-04 IS ADJUVANT RADIATION THERAPY UNDER-UTILIZED IN HIGH-RISK POST-PROSTATECTOMY PATIENTS? Matthew Maurice, Hui Zhu, and Robert Abouassaly Matthew MauriceMatthew Maurice More articles by this author , Hui ZhuHui Zhu More articles by this author , and Robert AbouassalyRobert Abouassaly More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2429AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Based on level 1 evidence, adjuvant radiation therapy (aRT) improves cancer control in post-prostatectomy patients with adverse pathologic features. We sought to evaluate its utilization and to identify factors affecting of its use. METHODS Using the National Cancer Database, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, we identified men diagnosed with prostate cancer between 2004-2011 who were found to have pT3 disease or pT2 disease with positive margins following prostatectomy. We defined aRT as radiation to the prostate and/or pelvis ≤6 months after prostatectomy. We then used univariate and multivariate logistic regression models to assess potential patient and provider predictors of aRT use. RESULTS We evaluated 103,092 men who had either pT3 disease (81%) or pT2 with positive margins (19%). Of these, we identified 10,043 men (9.7%) who received aRT. Since 2004, there has been a steady decline in aRT usage with time (range, 11.5% to 7.8%). Compared to 2004, patients diagnosed in 2011 were significantly less likely to receive aRT (odds ratio [OR] 0.78, confidence interval [CI] 0.71-0.85, p<0.0001). Higher Gleason score and T stage were strongly associated with positive aRT utilization (p<0.0001), while increasing age was associated with decreased use (p<0.0001). Another strong predictor of aRT uptake was hospital type. Compared to patients treated at community hospitals, patients treated at comprehensive cancer centers or teaching hospitals were significantly less likely to receive aRT (OR 0.63, 0.58-0.68, p<0.0001 or OR 0.42, CI 0.39-0.46, p<0.0001, respectively). Charlson score and hospital location were significantly but weakly associated with aRT. Other demographic variables were not predictive of aRT. CONCLUSIONS Post-prostatectomy aRT use is declining despite evidence of its benefit. Consistent with the evidence, patients with risk factors for biochemical relapse (i.e. high Gleason score or T3 disease) and younger patients, who are more likely to benefit, are receiving aRT. Surprisingly, aRT use is lower at teaching hospitals, which may reflect higher usage of salvage radiation. Multivariate Analysis of Predictive Factors for Adjuvant Radiation Therapy Utilization Variable Odds Ratio Confidence Interval P-value Year of Diagnosis, 2007 vs 2004 0.826 0.752-0.907 0.0257 Year of Diagnosis, 2008 vs 2004 0.81 0.738-0.889 < 0.01 Year of Diagnosis, 2009 vs 2004 0.868 0.792-0.951 0.5230 Year of Diagnosis, 2010 vs 2004 0.855 0.782-0.934 0.2157 Year of Diagnosis, 2011 vs 2004 0.781 0.714-0.854 < 0.0001 Age, 50-59 years vs < 50 years 0.821 0.742-0.910 < 0.0001 Age, 60-69 years vs < 50 years 0.677 0.611-0.751 0.0184 Age, 70-79 years vs < 50 yrs 0.566 0.501-0.641 0.3871 Age, >80 years vs < 50 years 0.239 0.143-0.399 < 0.0001 Charlson score, 1 vs 0 0.826 0.775-0.880 < 0.01 Charlson score, ≥2 vs 0 0.922 0.789-1.077 0.8557 Gleason score, >6 vs ≤6 1.940 1.812-2.078 < 0.0001 Stage, pT3 vs pT2 3.039 2.796-3.303 < 0.0001 Hospital type, comprehensive cancer center vs community 0.628 0.581-0.680 < 0.0001 Hospital type, teaching vs community 0.424 0.390-0.461 < 0.0001 Hospital type, other vs community 0.372 0.306-0.452 < 0.0001 Hospital location, south vs northeast 0.840 0.786-0.897 < 0.0001 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e897 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Matthew Maurice More articles by this author Hui Zhu More articles by this author Robert Abouassaly More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...