ESMO 2022: Radiotherapy Alone After Surgery Effective for Some Patients With Prostate Cancer
Study also shows two years of hormone therapy more effective than six months of treatment for high-risk patients
MONDAY, Sept. 19, 2022 (HealthDay News) – Patients with prostate cancer who struggle with the side effects of hormone therapy may benefit from radiotherapy alone, while two years of androgen deprivation therapy (ADT) appears to be more effective than six months of treatment for patients at high risk for recurrence of prostate cancer, according to a study presented at the annual meeting of the European Society of Medical Oncology, held Sept. 9 to 13 in Paris.
Chris Parker, M.D., from the Royal Marsden NHS Foundation Trust and the Institute of Cancer Research in London, and colleagues evaluated the outcomes of patients who received no ADT (“none”), six months of ADT (“short”), or 24 months of ADT (“long”) along with postoperative radiotherapy for prostate cancer. The study, part of the RADICALS protocol, encouraged three-way randomization and two-way randomization between none-versus-short or short-versus-long. The primary outcome measure was metastasis-free survival (MFS), while secondary outcomes included time to salvage ADT and overall survival (OS).
Researchers evaluated 2,839 patients, including 492 in the three-way randomization, 1,480 patients entering the none-versus-short comparison, and 1,523 patients entering the short-versus-long comparison. In a median follow-up of nine years for the none-versus-short group, based on 268 MFS events, six months of ADT did not improve MFS (hazard ratio [HR], 0.89; 95 percent confidence interval [CI], 0.69 to 1.14), and the time to salvage ADT was delayed (HR, 0.54; 95 percent CI, 0.42 to 0.70); however, OS was not improved (HR, 0.88; 95 percent CI, 0.65 to 1.19).
In the short-versus-long group, based on 313 MFS events, 24 months of ADT improved MFS (HR, 0.77; 95 percent CI, 0.61 to 0.97), while time to salvage ADT was delayed (HR, 0.73; 95 percent CI, 0.59 to 0.91). Similar to the none-versus-short group, OS was not improved in the short-versus-long group (HR, 0.88; 95 percent CI, 0.66 to 1.17).
The study authors concluded that in patients having postoperative RT after radical prostatectomy, 24 months of ADT versus six months of ADT improved both time to salvage ADT and MFS; while six months of ADT versus no ADT improved time to salvage ADT but did not improve MFS.
“The new information from this important study will ensure clinicians can better tailor treatment for prostate cancer patients following surgery and help facilitate important discussions,” Parker said in a press release. “This will mean some receive a more effective treatment while sparing others unnecessary intervention. We already knew prostate cancer patients initially treated with radiotherapy benefitted from hormone therapy. However, we did not know whether hormone therapy would also benefit those receiving radiotherapy after prostate surgery.”
With regard to the potential benefits for patients, Parker said, “The risk of metastases is reduced in patients undergoing radiotherapy and androgen deprivation therapy following radical prostatectomy. The trial showed encouraging results for radiotherapy without hormone therapy so some patients, concerned with upsetting side effects of hormone therapy, can be reassured this treatment alone is a good option.”
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