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

Autor: Roach M 3RD, J, Lu, M V, Pilepich, S O, Asbell, M, Mohiuddin, R, Terry, D, Grignon, C, Lawton, W, Shipley, J, Cox, M, Mohuidden
Rok vydání: 2000
Předmět:
Oncology
Male
Cancer Research
medicine.medical_specialty
Antineoplastic Agents
Hormonal
medicine.medical_treatment
Adenocarcinoma
Androgen suppression
law.invention
Gonadotropin-Releasing Hormone
Prostate cancer
Randomized controlled trial
law
Internal medicine
medicine
Multicenter Studies as Topic
Humans
Radiology
Nuclear Medicine and imaging
Prospective Studies
Prospective cohort study
Survival analysis
Proportional Hazards Models
Randomized Controlled Trials as Topic
Clinical Trials as Topic
Radiation
business.industry
Goserelin
Prostatic Neoplasms
Androgen Antagonists
Prostate-Specific Antigen
medicine.disease
Combined Modality Therapy
Survival Analysis
Flutamide
Surgery
Radiation therapy
Clinical trial
Prostate-specific antigen
Treatment Outcome
Clinical Trials
Phase III as Topic
Chemotherapy
Adjuvant
Meta-analysis
Hormonal therapy
business
medicine.drug
Zdroj: International journal of radiation oncology, biology, physics. 47(3)
ISSN: 0360-3016
Popis: Purpose: To assess the impact of short-term and long-term androgen suppression on the disease-specific and overall survival of 2200 men treated with radiotherapy on one of 5 prospective randomized trials when stratified by prognostic risk groups. Methods and Materials: Between 1975 and 1992, 2742 men were treated for clinically localized prostate cancer on one of 5 consecutive prospective Phase III randomized trials. Patients were selected for this analysis if they were deemed evaluable and eligible for the trial, and if follow-up information was available. For this analysis patients were stratified into four previously described prognostic risk groups: Group 1 patients had a Gleason score (GS) = 2–6, and T1–2Nx; Group 2: GS=2–6, T3Nx; or GS=2–6, N+, or GS=7, T1–2Nx; Group 3: T3Nx, GS=7; or N+, GS=7, or T1–2Nx, GS=8–10; and Group 4 patients were T3Nx, GS=8–10, or N+, GS=8–10. The median pretreatment prostate-specific antigen (PSA) was 25 ng/ml for the 434 evaluable patients for whom this information was available. The median follow-up times for patients treated on early studies exceeded 11 years, and for more recent studies 6 years. Results: Risk group 2 patients with "bulky" or T3 disease appeared to have a disease-specific survival benefit at 8 years with the addition of 4 months of goserelin and flutamide. Group 3 and 4 patients were noted to have an approximately 20% higher survival at 8 years with the addition of long-term hormonal therapy ( p ≤ 0.0004). Conclusions: Based on this meta-analysis of RTOG trials, subsets of patients can be identified who either do not appear to benefit from the use of hormonal therapy, benefit from short-term hormonal therapy, or who benefit only from long-term hormonal therapy. These observations should be confirmed by prospective randomized trials before they can be considered conclusive. In the meantime, however, these observations provide rational guidelines for deciding who should receive hormonal therapy and for how long.
Databáze: OpenAIRE
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