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Title: Physician Beliefs and Practices for Adjuvant and Salvage Radiation Therapy After Prostatectomy

Abstract

Purpose: Despite results of randomized trials that support adjuvant radiation therapy (RT) after radical prostatectomy (RP) for prostate cancer with adverse pathologic features (APF), many clinicians favor selective use of salvage RT. This survey was conducted to evaluate the beliefs and practices of radiation oncologists (RO) and urologists (U) regarding RT after RP. Methods and Materials: We designed a Web-based survey of post-RP RT beliefs and policies. Survey invitations were e-mailed to a list of 926 RO and 591 U. APF were defined as extracapsular extension, seminal vesicle invasion, or positive surgical margin. Differences between U and RO in adjuvant RT recommendations were evaluated by comparative statistics. Multivariate analyses were performed to evaluate factors predictive of adjuvant RT recommendation. Results: Analyzable surveys were completed by 218 RO and 92 U (overallresponse rate, 20%). Adjuvant RT was recommended based on APF by 68% of respondents (78% RO, 44% U, p <0.001). U were less likely than RO to agree that adjuvant RT improves survival and/or biochemical control (p < 0.0001). PSA thresholds for salvage RT were higher among U than RO (p < 0.001). Predicted rates of erectile dysfunction due to RT were higher among U than RO (p <0.001). Onmore » multivariate analysis, respondent specialty was the only predictor of adjuvant RT recommendations. Conclusions: U are less likely than RO to recommend adjuvant RT. Future research efforts should focus on defining the toxicities of post-RP RT and on identifying the subgroups of patients who will benefit from adjuvant vs. selective salvage RT.« less

Authors:
;  [1];  [2];  [3]; ;  [4];  [1];  [5];  [6];  [4]
  1. Department of Radiation Oncology, Jefferson Medical College, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States)
  2. Strategic Consulting, Thomson Reuters Healthcare, Cambridge, MA (United States)
  3. Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA (United States)
  4. Department of Urology, Jefferson Medical College and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States)
  5. Department of Medical Oncology, Jefferson Medical College and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States)
  6. School of Pharmacy, Thomas Jefferson University, Philadelphia, PA (United States)
Publication Date:
OSTI Identifier:
22056051
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 82; Journal Issue: 2; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; MEDICAL PERSONNEL; MULTIVARIATE ANALYSIS; NEOPLASMS; PATIENTS; PROSTATE; RADIOTHERAPY; RECOMMENDATIONS; SURGERY; TOXICITY

Citation Formats

Showalter, Timothy N., E-mail: timothy.showalter@jeffersonhospital.org, Ohri, Nitin, Teti, Kristopher G, Foley, Kathleen A, Keith, Scott W, Trabulsi, Edouard J, Lallas, Costas D, Dicker, Adam P, Hoffman-Censits, Jean, Pizzi, Laura T, and Gomella, Leonard G. Physician Beliefs and Practices for Adjuvant and Salvage Radiation Therapy After Prostatectomy. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2011.04.003.
Showalter, Timothy N., E-mail: timothy.showalter@jeffersonhospital.org, Ohri, Nitin, Teti, Kristopher G, Foley, Kathleen A, Keith, Scott W, Trabulsi, Edouard J, Lallas, Costas D, Dicker, Adam P, Hoffman-Censits, Jean, Pizzi, Laura T, & Gomella, Leonard G. Physician Beliefs and Practices for Adjuvant and Salvage Radiation Therapy After Prostatectomy. United States. https://doi.org/10.1016/J.IJROBP.2011.04.003
Showalter, Timothy N., E-mail: timothy.showalter@jeffersonhospital.org, Ohri, Nitin, Teti, Kristopher G, Foley, Kathleen A, Keith, Scott W, Trabulsi, Edouard J, Lallas, Costas D, Dicker, Adam P, Hoffman-Censits, Jean, Pizzi, Laura T, and Gomella, Leonard G. 2012. "Physician Beliefs and Practices for Adjuvant and Salvage Radiation Therapy After Prostatectomy". United States. https://doi.org/10.1016/J.IJROBP.2011.04.003.
@article{osti_22056051,
title = {Physician Beliefs and Practices for Adjuvant and Salvage Radiation Therapy After Prostatectomy},
author = {Showalter, Timothy N., E-mail: timothy.showalter@jeffersonhospital.org and Ohri, Nitin and Teti, Kristopher G and Foley, Kathleen A and Keith, Scott W and Trabulsi, Edouard J and Lallas, Costas D and Dicker, Adam P and Hoffman-Censits, Jean and Pizzi, Laura T and Gomella, Leonard G},
abstractNote = {Purpose: Despite results of randomized trials that support adjuvant radiation therapy (RT) after radical prostatectomy (RP) for prostate cancer with adverse pathologic features (APF), many clinicians favor selective use of salvage RT. This survey was conducted to evaluate the beliefs and practices of radiation oncologists (RO) and urologists (U) regarding RT after RP. Methods and Materials: We designed a Web-based survey of post-RP RT beliefs and policies. Survey invitations were e-mailed to a list of 926 RO and 591 U. APF were defined as extracapsular extension, seminal vesicle invasion, or positive surgical margin. Differences between U and RO in adjuvant RT recommendations were evaluated by comparative statistics. Multivariate analyses were performed to evaluate factors predictive of adjuvant RT recommendation. Results: Analyzable surveys were completed by 218 RO and 92 U (overallresponse rate, 20%). Adjuvant RT was recommended based on APF by 68% of respondents (78% RO, 44% U, p <0.001). U were less likely than RO to agree that adjuvant RT improves survival and/or biochemical control (p < 0.0001). PSA thresholds for salvage RT were higher among U than RO (p < 0.001). Predicted rates of erectile dysfunction due to RT were higher among U than RO (p <0.001). On multivariate analysis, respondent specialty was the only predictor of adjuvant RT recommendations. Conclusions: U are less likely than RO to recommend adjuvant RT. Future research efforts should focus on defining the toxicities of post-RP RT and on identifying the subgroups of patients who will benefit from adjuvant vs. selective salvage RT.},
doi = {10.1016/J.IJROBP.2011.04.003},
url = {https://www.osti.gov/biblio/22056051}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 82,
place = {United States},
year = {Wed Feb 01 00:00:00 EST 2012},
month = {Wed Feb 01 00:00:00 EST 2012}
}