Comparison of three radiotherapy modalities on biochemical control and overall survival for the treatment of prostate cancer: A systematic review

Background and PurposeFor 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.Materials and methodsA 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).ResultsThe 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.ConclusionThe 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.