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A randomized Phase II trial of High Dose-Rate (HDR) and Low Dose-Rate (LDR) brachytherapy as monotherapy in localized prostate cancer: analysis of initial arms of Canadian cancer trials group PR19 (NCT02960087).

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Variation in Radiotherapy Referral and Treatment for High-risk Pathological Features after Radical Prostatectomy:

C J Jin1, T P Hanna2, E F Cook3

  • 1Department of Oncology, Cancer Center of Southeastern Ontario at Kingston General Hospital, Queen's University, Kingston, Ontario, Canada; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.

Clinical Oncology (Royal College of Radiologists (Great Britain))
|November 7, 2017
PubMed
Summary

Adjuvant radiotherapy referral and treatment post-prostatectomy vary widely and are not fully explained by patient factors. Pathological findings strongly influence treatment decisions after radiation oncology consultation for high-risk prostate cancer.

Keywords:
Access and evaluationhealth care qualityphysician's practice patternsprostatectomyprostatic neoplasmsradiation oncology

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Area of Science:

  • Urology
  • Radiation Oncology
  • Health Services Research

Background:

  • Guidelines recommend adjuvant radiotherapy discussions for high-risk prostate cancer patients post-prostatectomy.
  • Contemporary practice patterns for radiotherapy referral and treatment require evaluation.

Purpose of the Study:

  • To determine if radiotherapy referral and use post-prostatectomy align with guideline recommendations.
  • To identify factors influencing radiotherapy referral and treatment in a contemporary cohort.

Main Methods:

  • Retrospective analysis of electronic treatment records linked to the Ontario cancer registry.
  • Multivariable regression to assess clinical and health system factors associated with referral and treatment within 6 months post-prostatectomy.

Main Results:

  • Of 2663 patients, 47% had adverse pathology; 492 were referred for radiotherapy, and 51% received it.
  • Referral was associated with low-volume surgical facilities, greater distance to radiotherapy centers, preoperative radiation oncology visits, and adverse pathology (high T-category, positive margins, high Gleason score).
  • Geographic variations in referral rates (6-66%) were significant; high T-category and non-apex positive margins predicted treatment post-referral.

Conclusions:

  • Referral variations are not primarily driven by patient characteristics.
  • Pathological findings are the strongest predictors of treatment decisions after radiation oncology consultation.
  • Further investigation is needed to understand non-clinical variations in care and ensure equitable access to potentially curative radiotherapy.