Additional radiotherapy extends survival of hormone-treated prostate patients
MedWire News: Study results show a significant survival benefit for men with locally advanced prostate cancer who receive radiotherapy (RT) and androgen deprivation therapy (ADT), as opposed to hormone therapy alone.
In addition to reduced overall mortality, ADT patients treated with additional RT also had reduced disease-specific mortality, and showed no significant increase in toxicity compared with ADT-only patients.
“We’re confident that RT should be part of the treatment package in this group of patients,” said Padraig Warde, from the University of Toronto in Ontario, Canada, who presented the research at the American Society of Clinical Oncology in Chicago, Illinois, USA, this week.
The research team investigated the effect on overall survival of RT added to lifelong ADT in a cohort of 1205 ADT-treated patients with stage T3/4 disease (n=1057), T2 stage disease with a prostate-specific antigen (PSA) level above 40 µg/l (n=119), or T2 disease, a PSA of 20 µg/l or more, and a Gleason score of 8 or higher (n=25).
A total of 603 men were randomly assigned to receive 65–69 Gy to the prostate and/or seminal vesicles, with or without 45 Gy to the pelvic nodes. After a median follow-up of 6 years, 175 ADT-only and 145 ADT-plus-RT patients had died, a total of 140 of whom died of prostate cancer or treatment-related effects.
The addition of RT to ADT reduced overall death rates during follow-up by a significant 23% compared with ADT treatment alone, report Warde et al. Furthermore, the risk for prostate cancer-specific mortality was reduced by 43% in RT plus ADT-treated patients.
“We feel we’ve shown that patients treated with combined treatment, radiation and hormonal [therapy], live longer and are less likely to die of prostate cancer,” said Warde.
The researchers also evaluated toxicity levels in both groups of patients and found similar rates in both treatment arms. Specifically, proctitis occurred in 1.3% of patients in the ADT-only treatment group, and 1.8% of the ADT-plus-RT treatment group.
“It’s interesting to note that it’s possible that we underestimated the benefit of RT, as with the changes in technology over the past decade, radiation oncologists have been able to put much higher doses of radiation into the prostate than used in this study,” remarked Warde.
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By Sarah Guy