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Patterns of use and patient characteristics: brachytherapy for localized prostate cancer in octo- and nonagenarians

Valdivieso, Roger; Boehm, Katharina; Meskawi, Malek; Larcher, Alessandro; Tian, Zhe; Parent, Marie-Élise; Wong, Philip; Graefen, Markus; Montorsi, Francesco; Sun, Maxine; Saad, Fred; Karakiewicz, Pierre I (2015). Patterns of use and patient characteristics: brachytherapy for localized prostate cancer in octo- and nonagenarians World Journal of Urology , vol. 33 , nº 12. p. 1985-1991. DOI: 10.1007/s00345-015-1553-0.

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Résumé

Background Brachytherapy (BT) is a widely used treatment modality for elderly patients with localized prostate cancer (PCa). Objective To describe the patterns of BT use in octo- and nonagenarians treated for localized PCa in the USA. We hypothesized that most individuals treated with BT should remain alive for at least 10 years. We also postulated that BT should ideally be administered as monotherapy. Patients and methods Using the Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, 2701 octo- and nonagenarians treated with BT between 1992 and 2009 were identified. Cumulative incidence rates and smoothed cumulative incidence plots were used. Results In patients with low-risk characteristics, 40 % received BT alone; 27 % received BT combined with ADT; 19 % received BT and EBRT; and 14 % received BT combined with both ADT and EBRT. Of intermediate-to-high-risk patients, 19 % received BT alone; 16 % received BT combined with ADT; 19 % received BT combined with EBRT; and 45 % received BT together with ADT and EBRT. Overall survival rate was 79 and 47 % at 5 and 10 years. Conclusions Less than half of elderly treated with BT remain alive at 10 years of follow-up. Moreover, the vast majority of those individuals not only receives BT, but is also exposed to two or even three combined therapy modalities. These findings are worrisome.

Type de document:
Mots-clés libres: Localized prostate cancer ; Octo- and nonagenarians ; Elderly patients ; Brachytherapy ; Survival ; Prostate cancer
Centre: Centre INRS-Institut Armand Frappier
Date de dépôt: 29 mai 2017 19:56
Dernière modification: 29 mai 2017 19:56
URI: http://espace.inrs.ca/id/eprint/3262

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