Dose Escalated Radiotherapy Alone or in Combination With Short-Term Androgen Suppression for Intermediate Risk Prostate Cancer: Outcomes From the NRG Oncology/RTOG 0815 Randomized Trial

Krauss, Daniel; Karrison, Theodore; Martínez, Álvaro; Morton, G.; Yan, Di; Bruner, Deborah Watkins; Movsas, Benjamin; Elshaikh, M.A.; Citrin, Deborah E.; Hershatter, Bruce; Michalski, Jeff M.; Efstathiou, Jason A.; Currey, Adam; Kavadi, Vivek S.; Cury, Fabio; Lock, Michael; Raben, Adam; Sandler, Howard M.

doi:10.1016/j.ijrobp.2021.07.039

Cited by 18 publications

(25 citation statements)

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“…Our series represents the largest series of patients treated with a single, consistent technique: dose-escalated IMRT with daily IGRT. RTOG 9408 demonstrated an improvement in OS with 4 months of ADT before and during radiation to total dose of 66.6 Gy to the prostate3; however, more recent studies have been unable to show the same improvement in OS 4,7,8,15,18,19…”

Section: Discussionmentioning

confidence: 99%

“…OS was similar between groups at 5 (90% to 91%) and 8 (79% to 84%) years ( P =0.22). NRG-RTOG 0815, however, enrolled patients treated with dose-escalated external beam as well as patients treated with combination external beam therapy with brachytherapy boosts 15…”

Section: Discussionmentioning

confidence: 99%

“…NRG-RTOG 0815, however, enrolled patients treated with dose-escalated external beam as well as patients treated with combination external beam therapy with brachytherapy boosts. 15 The largest retrospective series addressing concurrent ADT in patients treated with dose escalation is from Memorial Sloan-Kettering Cancer Center. More than 700 IR patients treated with dose-escalated RT ( ≥ 81 Gy) between 1992 and 2005 were reviewed, with 50.3% of patients receiving ADT, mostly for 6 months duration.…”

Section: Discussionmentioning

confidence: 99%

“…Our experience represents one of the largest retrospective studies available with patients treated solely with IMRT and daily IGRT with or without short-term concurrent/adjuvant ADT. All other series included patients treated in the 1990s and/or included patients treated with conventional fractionation RT, brachytherapy alone, or brachytherapy boosts 2–4,7–9,15–17 Table 3. compares our series to similar prospective and retrospective studies.…”

Section: Discussionmentioning

confidence: 99%

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Short-term ADT and Dose-escalated IMRT in Patients With Intermediate-risk Prostate Cancer

Post¹,

Kahn²,

Turina³

et al. 2022

American Journal of Clinical Oncology

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Objectives: In the era of dose-escalated prostate radiation therapy (RT), the use of androgen deprivation therapy (ADT) is undefined for intermediate-risk (IR) prostate cancer. There is growing concern of the risk of ADT to be detrimental to quality of life. This single-institution retrospective analysis aimed to evaluate outcomes of IR patients treated with dose-escalated intensity modulated radiation therapy (IMRT) with or without concurrent/adjuvant short-term ADT. Materials and Methods: Data was collected from 260 consecutive patients treated with dose-escalated IMRT with daily image-guided RT for newly diagnosed IR prostate cancer. Biochemical recurrence-free survival (BCRFS), distant metastasis-free survival, prostate cancer-specific survival, and overall survival (OS) were calculated using Kaplan-Meier methodology. Results: Median follow-up was 93 months. A total of 181 patients had unfavorable IR disease, and 36.2% (N=94) received ADT, with median ADT duration of 6 months. Seven-year BCRFS was 94.1% vs. 86.2% (P=0.067), for ADT and no ADT, respectively, and no difference in distant metastasis-free survival or prostate cancer-specific survival was observed. ADT was associated with significantly worse 7-year OS (80.0% vs. 91.3%, P=0.010). Analysis of the unfavorable IR cohort alone, showed similar results; 7-year BCRFS and 7-year OS in patients who received ADT versus no ADT were 93.7% vs. 85.9% (P=0.093), and 79.0% vs. 90.6% (P=0.019), respectively. Conclusions: In our 15-year experience treating IR prostate cancer with dose-escalated IMRT with daily image-guided RT, short-term concurrent ADT was associated with a statistically significant worse OS. Additional studies are needed to determine if ADT is beneficial or detrimental for patients with IR prostate cancer treated with dose-escalated radiation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Short-term ADT and Dose-escalated IMRT in Patients With Intermediate-risk Prostate Cancer

Post¹,

Kahn²,

Turina³

et al. 2022

American Journal of Clinical Oncology

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“…6 Based on NRG/RTOG 0815, and the Meta-Analysis of Randomized trials in Cancer of the Prostate consortium, ADT consistently reduces the risk of biochemical recurrence, distant metastasis, and prostate cancer−specific mortality across the disease risk spectrum. 7,8 Absolute benefit, however, is a function of baseline risk. Stated explicitly, the 30% to 60% risk reduction benefit from adding ADT to EBRT is quite different for a man with a baseline distant metastasis risk of 5% versus one with a 20% baseline risk.…”

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confidence: 99%

Personalized Medicine in Localized Prostate Cancer: Are We There Yet?

Dess

2022

International Journal of Radiation Oncology*Biology*Physics

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The effect of dose‐escalation radiotherapy with simultaneous‐integrated‐boost on the use of short‐term androgen deprivation therapy in patients with intermediate risk prostate cancer

Onal,

Guler,

Erbay

et al. 2024

The Prostate

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PurposeTo compare the biochemical failure (FFBF) and prostate cancer specific survival (PCSS) rates of patients with intermediate‐risk prostate cancer (IR‐PC) who were treated with 6 months of androgen deprivation therapy (ADT) with 78 Gy to the prostate, those treated with ADT and focal boost (FB) of 86 Gy to intraprostatic lesion (IPL) using the simultaneous‐integrated boost (SIB) technique, and those treated with SIB alone.Materials and MethodsA retrospective analysis of 320 IR‐PC patients treated between January 2012 and April 2021 was performed. Patients were divided into three groups based on their treatment arm: 78 + ADT (109 patients, 34.1%), 78/86 (102 patients, 31.8%), and 78/86 + ADT. Univariable and multivariable analyses were used to determine prognostic factors for FFBF and PCSS.ResultsMedian follow‐up was 8.8 years. The 8‐year FFBF and PCSS rates were 88.6% and 99.0%. Patients who received ADT had significantly higher pretreatment PSA levels and clinical tumor stage. Disease progression occurred in 45 patients (7.3%) at a median of 41.9 months after definitive radiotherapy (RT). Younger age, positive core biopsy (PCB) ≥ 50%, and the absence of ADT were all independent predictors of poor FFBF in multivariate analysis, whereas patients with PCB < 50% who were also given ADT had better PCSS. Patients treated with 78/86 Gy alone had worse FFBF than those treated with 78 Gy and ADT (Hazard ratio [HR] = 3.39 [95% CI = 1.46–7.88]; p = 0.005), as well as than those treated with 78/86 Gy and ADT (HR = 3.21 [95% CI = 1.23–6.46]; p = 0.009). However, FB to IPL has no effect on PCSS in multivariable analysis. There was no significant difference between treatment groups in terms of acute and late Grade ≥2 genitourinary or gastrointestinal toxicity.ConclusionsOur findings demonstrated that patients who received 78/86 alone did worse than patients who received ADT with either 78 or 78/86 Gy. However, because IR‐PC patients are so diverse, additional prospective trials are needed to validate our findings.

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Dose Escalated Radiotherapy Alone or in Combination With Short-Term Androgen Suppression for Intermediate Risk Prostate Cancer: Outcomes From the NRG Oncology/RTOG 0815 Randomized Trial

Cited by 18 publications

References 0 publications

Short-term ADT and Dose-escalated IMRT in Patients With Intermediate-risk Prostate Cancer

Short-term ADT and Dose-escalated IMRT in Patients With Intermediate-risk Prostate Cancer

Personalized Medicine in Localized Prostate Cancer: Are We There Yet?

The effect of dose‐escalation radiotherapy with simultaneous‐integrated‐boost on the use of short‐term androgen deprivation therapy in patients with intermediate risk prostate cancer

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