Predicting long-term survival, and the need for hormonal therapy: a meta-analysis of RTOG prostate cancer trials

Roach, Mack; Lu, Jiandong; Pilepich, Miljenko V.; Asbell, Sucha O.; Mohuidden, Mohammed; Terry, Roger; Grignon, David J.; Lawton, C.A.; Shipley, W.; Cox, Jerry

doi:10.1016/s1278-3218(00)00075-5

Cited by 11 publications

(18 citation statements)

References 3 publications

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“…Several studies with longer follow-up periods have also shown that most patients have an increasing risk of biochemical failure within 36 months, but few fail beyond 4 years. [11,16] As expected, the AJCC stage and risk stratification was statistically significant in DFS but not in OAS, probably due to the less number of patients. The reported benefit of combination of radiation therapy and androgen suppression in high-risk patients seen in RTOG and European Organization for Research and Treatment of Cancer (EORTC) trials was not evident in our subset of patients, which could be due to the heterogeneous duration of the treatment.…”

Section: Discussionsupporting

confidence: 62%

“…Various institutional and multiinstitutional studies of dose escalation with 3DCRT in prostate cancer have consistently shown an improvement in biochemical disease-free survival (bDFS) and local control with increased dose of radiation. [6][7][8][9][10][11] Another recent advancement in the treatment of prostate cancer is the combined treatment using androgen deprivation and radiotherapy (RT) in selected patients, particularly those with locally advanced, unfavorable-risk disease. [12][13][14][15][16][17] Both adjuvant [14] and neoadjuvant hormone therapy (NAHT) [12] have been shown to improve the outcomes in patients treated with radiation.…”

Section: Introductionmentioning

confidence: 99%

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From two-dimensional to three-dimensional conformal radiotherapy in prostate cancer: An Indian experience

et al. 2010

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

From two-dimensional to three-dimensional conformal radiotherapy in prostate cancer: An Indian experience

et al. 2010

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“…Given the known relationship of PSA > 20 ng/ml with inferior outcomes, the concern of occult micrometastatic disease is further intensified when PSA values are found to be extremely high at time of diagnosis [10, 29, 30]. In a report by Ou et al, patients that present with baseline serum PSA levels greater than 50 ng/ml were found to have higher rates of extracapsular disease and lymph node metastases, higher Gleason scores and tumor burden, and shorter freedom from PSA failure when compared to patients with PSA levels between 20.1-50 ng/ml [10].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Roach et al, demonstrated that high risk prostate cancer patients treated with radiotherapy alone with no systemic therapy (e.g. hormonal therapy) with baseline serum PSA levels greater than 100 ng/ml had statistically and clinical significant deteriorations in overall survival [30]. …”

Section: Discussionmentioning

confidence: 99%

Impact of Ultrahigh Baseline PSA Levels on Biochemical and Clinical Outcomes in Two Radiation Therapy Oncology Group Prostate Clinical Trials

Rodrigues

Bae

Roach

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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Purpose To assess ultra-high (UH; PSA ≥ 50 ng/ml) patient outcomes compared to other high-risk patients and to identify outcome predictors. Methods and Materials PCP from two Phase III RTOG clinical trials (9202 and 9413) were divided into two groups; high-risk patients with and without UH baseline PSA level. Predictive variables included age, Gleason score, clinical T stage, KPS, and treatment arm. Outcomes included overall survival (OS), distant metastasis (DM), and biochemical failure (BF). Unadjusted and adjusted hazard ratios (HRs) were calculated using either the Cox or Fine and Gray’s regression model with associated 95% confidence intervals (CI) and p-values. Results There were 401 in the UH PSA and 1792 in the non-UH PSA PCP out of 2193 high risk PCP. PCP with UH PSA was found to have inferior OS (HR 1.19, 95% CI 1.02-1.39, p-value=0.02), DM (HR 1.51, 95% CI 1.19-1.92, p-value=0.0006), and BF (HR 1.50, 95% CI 1.29-1.73, p-value <0.0001) when compared to other high-risk PCP. In the UH cohort, PSA was found to be a significant factor for the risk of DM (HR 1.01, 95% CI 1.001-1.02) but not OS and BF. Gleason grade 8-10 was found to consistently predict for poor OS, DM, and BF outcomes (with HR estimates ranging from 1.41 to 2.36) in both the high-risk cohort and UH cohort multivariable analyses. Conclusions UH PSA levels at diagnosis are related with detrimental changes in OS, DM, and BF. All three outcomes can be modelled by various combinations all predictive variables tested.

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“…This model was based on data from the largest prospective Phase III Trials evaluated to date and was also useful for defining who should be prescribed androgen deprivation therapy and whether it should be prescribed short or long term 36. This model was subsequently validated using multi-institutional data and is useful in first elucidating the impact of pretreatment PSA on overall and cause specific survival 37.…”

Section: Predictive Models Using Standard Pretreatment Clinical Featuresmentioning

confidence: 99%

Predictive models in external beam radiotherapy for clinically localized prostate cancer

Roach

Waldman

Pollack

2009

Cancer

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Predictive models are being used increasingly in effort to allow physician and patient expectations to be aligned with outcomes that are based on available data. Most predictive models for men who receive external beam radiotherapy for clinically localized prostate cancer are based on Gleason score, clinical tumor classification, and prostate-specific antigen (PSA) levels. More sophisticated models also have been developed that incorporate treatment-related variables, such as the dose of radiation and the use of androgendeprivation therapy. Most of the predictive models applied to prostate cancer were derived using PSA recurrence rates as the major endpoint, but clinical endpoints have been incorporated increasingly into predictive models. Biomarkers also are increasingly being added to predictive models in an effort to strengthen them. The Radiation Therapy Oncology Group (RTOG) has completed studies on a wide range of markers using tissue from 2 phase 3 trials (RTOG 8610 and 9202). To date, preliminary assessments of p53; DNA ploidy; p16/retinoblastoma 1 protein; Ki-67; mouse double-minute p53 binding protein homolog;Bcl-2/Bcl-2-associated X protein; cytosine, adenine, and guanine repeats; cyclooxygenase-2; signal transducer and activator of transcription 3; cytochrome P450 3A4; and protein kinase A have been completed.Although they are not ready for widespread, routine use, there are reasons to believe that future models will combine these markers with traditional pretreatment and treatment-related variables and will improve our ability to predict outcome and select the optimal treatment. KEY WORDS: prostate cancer, radiotherapy, randomized trials, predictive models.Many men receive external beam radiotherapy (EBRT) with curative intent for clinically localized prostate cancer. In an effort to give meaningful guidance to these men, several models have been developed to guide therapy and predict outcome. Most of these models have been based on standard pretreatment prognostic factors, including Gleason score, tumor stage (T classification), and, when available, prostatespecific antigen (PSA). In addition, treatment-related variables, such as radiation dose and androgendeprivation therapy (ADT), have been added to predictive models. These pretreatment and treatment-

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Predicting long-term survival, and the need for hormonal therapy: a meta-analysis of RTOG prostate cancer trials

Cited by 11 publications

References 3 publications

From two-dimensional to three-dimensional conformal radiotherapy in prostate cancer: An Indian experience

From two-dimensional to three-dimensional conformal radiotherapy in prostate cancer: An Indian experience

Impact of Ultrahigh Baseline PSA Levels on Biochemical and Clinical Outcomes in Two Radiation Therapy Oncology Group Prostate Clinical Trials

Predictive models in external beam radiotherapy for clinically localized prostate cancer

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