Radiation therapy dose and androgen deprivation therapy in localized prostate cancer: a meta-regression of 5-year outcomes in phase III randomized controlled trials.

Autor: Jiang T; Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.; Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA., Markovic D; Department of Medicine, Statistics Core, University of California, Los Angeles, CA, USA., Patel J; Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA., Juarez JE; Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA., Ma TM; Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA., Shabsovich D; Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA., Nickols NG; Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA., Reiter RE; Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA., Elashoff D; Department of Medicine, Statistics Core, University of California, Los Angeles, CA, USA., Rettig MB; Division of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.; Division of Hematology and Oncology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA., Zaorsky NG; Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA., Spratt DE; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA., Kishan AU; Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. aukishan@mednet.ucla.edu.; Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. aukishan@mednet.ucla.edu.
Jazyk: angličtina
Zdroj: Prostate cancer and prostatic diseases [Prostate Cancer Prostatic Dis] 2022 Mar; Vol. 25 (1), pp. 126-128. Date of Electronic Publication: 2021 Aug 16.
DOI: 10.1038/s41391-021-00432-2
Abstrakt: Background: While multiple randomized trials have evaluated the benefit of radiation therapy (RT) dose escalation and the use and prolongation of androgen deprivation therapy (ADT) in the treatment of prostate cancer, few studies have evaluated the relative benefit of either form of treatment intensification with each other. Many trials have included treatment strategies that incorporate either high or low dose RT, or short-term or long-term ADT (STADT or LTADT), in one or more trial arms. We sought to compare different forms of treatment intensification of RT in the context of localized prostate cancer.
Methods: Using preferred reporting items for systemic reviews and meta-analyses (PRISMA) guidelines, we collected over 40 phases III clinical trials comparing different forms of RT for localized prostate cancer. We performed a meta-regression of 40 individual trials with 21,429 total patients to allow a comparison of the rates and cumulative proportions of 5-year overall survival (OS), prostate cancer-specific mortality (PCSM), and distant metastasis (DM) for each treatment arm of every trial.
Results: Dose-escalation either in the absence or presence of STADT failed to significantly improve any 5-year outcome. In contrast, adding LTADT to low dose RT significantly improved 5-year PCSM (Odds ratio [OR] 0.34, 95% confidence interval [CI] 0.22-0.54, p < 0.001) and DM (OR 0.35, 95% CI 0.20-0.63. p < 0.001) over low dose RT alone. Adding STADT also significantly improved 5-year PCSM over low dose RT alone (OR 0.55, 95% CI 0.41-0.75, p < 0.001).
Conclusion: While limited by between-study heterogeneity and a lack of individual patient data, this meta-analysis suggests that adding ADT, versus increasing RT dose alone, offers a more consistent improvement in clinical endpoints.
(© 2021. The Author(s).)
Databáze: MEDLINE
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