ESTRO-ACROP recommendations for evidence-based use of androgen deprivation therapy in combination with external-beam radiotherapy in prostate cancer.

Autor: Schmidt-Hegemann NS; Department of Radiation Oncology, University Hospital, LMU Munich, Germany. Electronic address: Nina-Sophie.Hegemann@med.uni-muenchen.de., Zamboglou C; German Oncology Center, European University, Limassol, Cyprus; Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. Electronic address: constantinos.zamboglou@uniklinik-freiburg.de., Mason M; Division of Cancer and Genetics, Cardiff University School of Medicine, Heath Park, Cardiff, UK. Electronic address: masonmd@cardiff.ac.uk., Mottet N; Department of Urology, University Hospital St. Etienne, France. Electronic address: nicolas.mottet@chu-st-etienne.fr., Hinnen K; Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: k.a.hinnen@amsterdamumc.nl., De Meerleer G; Department of Radiation Oncology, Leuven University Hospitals, Belgium. Electronic address: gert.demeerleer@uzleuven.be., Cozzarini C; Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy. Electronic address: cozzarini.cesare@hsr.it., Maingon P; Department of Radiation Oncology, Sorbonne University, APHP.Sorbonne University, GHU La Pitié-Salpêtrière, Paris, France. Electronic address: philippe.maingon@aphp.fr., Henry A; Department of Radiotherapy, University of Leeds, UK. Electronic address: A.Henry@leeds.ac.uk., Spahn M; Department of Urology, Lindenhofspital, Bern, Switzerland. Electronic address: martin.spahn@lindenhofgruppe.ch., Cornford P; Department of Urology, Liverpool University Hospitals, Liverpool, UK. Electronic address: Philip.Cornford@liverpoolft.nhs.uk., Belka C; Department of Radiation Oncology, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Germany. Electronic address: claus.belka@med.uni-muenchen.de., Wiegel T; Department of Radiation Oncology, University Hospital Ulm, Germany. Electronic address: thomas.wiegel@uniklinik-ulm.de.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2023 Jun; Vol. 183, pp. 109544. Date of Electronic Publication: 2023 Feb 20.
DOI: 10.1016/j.radonc.2023.109544
Abstrakt: Background and Purpose: There is no consensus concerning the appropriate use of androgen deprivation therapy (ADT) during primary and postoperative external-beam radiotherapy (EBRT) in the management of prostate cancer (PCa). Thus, the European Society for Radiotherapy and Oncology (ESTRO) Advisory Committee for Radiation Oncology Practice (ACROP) guidelines seeks to present current recommendations for the clinical use of ADT in the various indications of EBRT.
Material and Methods: A literature search was conducted in MEDLINE PubMed that evaluated EBRT and ADT in prostate cancer. The search focused on randomized, Phase II and III trials published in English from January 2000 to May 2022. In case topics were addressed in the absence of Phase II or III trials, recommendations were labelled accordingly based on the limited body of evidence. Localized PCa was classified according to D'Amico et al. classification in low-, intermediate and high risk PCa. The ACROP clinical committee identified 13 European experts who discussed and analyzed the body of evidence concerning the use of ADT with EBRT for prostate cancer.
Results: Key issues were identified and are discussed: It was concluded that no additional ADT is recommended for low-risk prostate cancer patients, whereas for intermediate- and high-risk patients four to six months and two to three years of ADT are recommended. Likewise, patients with locally advanced prostate cancer are recommended to receive ADT for two to three years and when ≥ 2 high-risk factors (cT3-4, ISUP grade ≥ 4 or PSA ≥ 40 ng/ml) or cN1 is present ADT for three years plus additional Abiraterone for two years is recommended. For postoperative patients no ADT is recommended for adjuvant EBRT in pN0 patients whereas for pN1 patients adjuvant EBRT with long-term ADT is performed for at least 24 to 36 months. In the setting of salvage EBRT ADT is performed in biochemically persistent PCa patients with no evidence of metastatic disease. Long-term ADT (24 months) is recommended in pN0 patients with high risk of further progression (PSA ≥ 0.7 ng/ml and ISUP grade group ≥ 4) and a life expectancy of over ten years, whereas short-term ADT (6 months) is recommended in pN0 patients with lower risk profile (PSA < 0.7 ng/ml and ISUP grade group 4). Patients considered for ultra-hypofractionated EBRT as well as patients with image based local recurrence within the prostatic fossa or lymph node recurrence should participate in appropriate clinical trials evaluating the role of additional ADT.
Conclusion: These ESTRO-ACROP recommendations are evidence-based and relevant to the use of ADT in combination with EBRT in PCa for the most common clinical settings.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023. Published by Elsevier B.V.)
Databáze: MEDLINE
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