Interplay Between Duration of Androgen Deprivation Therapy and External Beam Radiotherapy With or Without a Brachytherapy Boost for Optimal Treatment of High-risk Prostate Cancer: A Patient-Level Data Analysis of 3 Cohorts
| Autor: | Amar U. Kishan, Alison Steigler, James W. Denham, Almudena Zapatero, Araceli Guerrero, David Joseph, Xavier Maldonado, Jessica K. Wong, Bradley J. Stish, Robert T. Dess, Avinash Pilar, Chandana Reddy, Trude B. Wedde, Wolfgang A. Lilleby, Ryan Fiano, Gregory S. Merrick, Richard G. Stock, D. Jeffrey Demanes, Brian J. Moran, Phuoc T. Tran, Santiago Martin, Rafael Martinez-Monge, Daniel J. Krauss, Eyad I. Abu-Isa, Thomas M. Pisansky, C. Richard Choo, Daniel Y. Song, Stephen Greco, Curtiland Deville, Todd McNutt, Theodore L. DeWeese, Ashley E. Ross, Jay P. Ciezki, Derya Tilki, R. Jeffrey Karnes, Jeffrey J. Tosoian, Nicholas G. Nickols, Prashant Bhat, David Shabsovich, Jesus E. Juarez, Tommy Jiang, T. Martin Ma, Michael Xiang, Rebecca Philipson, Albert Chang, Patrick A. Kupelian, Matthew B. Rettig, Felix Y. Feng, Alejandro Berlin, Jonathan D. Tward, Brian J. Davis, Robert E. Reiter, Michael L. Steinberg, David Elashoff, Paul C. Boutros, Eric M. Horwitz, Rahul D. Tendulkar, Daniel E. Spratt, Tahmineh Romero |
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| Rok vydání: | 2022 |
| Předmět: |
Male
Data Analysis Urologic Diseases Cancer Research Research Prostate Cancer Brachytherapy Clinical Trials and Supportive Activities Oncology and Carcinogenesis Prostatic Neoplasms Evaluation of treatments and therapeutic interventions Androgen Antagonists Middle Aged Oncology Clinical Research 6.1 Pharmaceuticals Androgens Public Health and Health Services Online First Humans Comments Original Investigation Retrospective Studies Cancer |
| Zdroj: | JAMA oncology, vol 8, iss 3 JAMA Oncology |
| Popis: | Key Points Question What is the optimal minimum duration of androgen deprivation therapy (ADT) when treating high-risk prostate cancer with high-dose radiotherapy? Findings This patient-level cohort study of 3 cohorts found a significant interaction between the type of high-dose radiotherapy (external beam radiotherapy with or without a brachytherapy boost) and optimal duration. Prolonging ADT for 18 to 28 months was associated with a 63% reduction in death or metastasis with external beam radiotherapy; when a brachytherapy boost was added, the nonlinear association between ADT and distant metastasis-free survival was broad and spanned 12 months. Meaning The findings of this cohort study suggest that patients receiving external beam radiotherapy alone may benefit from ADT durations of 18 months or more; if a brachytherapy boost is added, a duration of 18 months or possibly less may be optimal. Importance Radiotherapy combined with androgen deprivation therapy (ADT) is a standard of care for high-risk prostate cancer. However, the interplay between radiotherapy dose and the required minimum duration of ADT is uncertain. Objective To determine the specific ADT duration threshold that provides a distant metastasis-free survival (DMFS) benefit in patients with high-risk prostate cancer receiving external beam radiotherapy (EBRT) or EBRT with a brachytherapy boost (EBRT+BT). Design, Settings, and Participants This was a cohort study of 3 cohorts assembled from a multicenter retrospective study (2000-2013); a post hoc analysis of the Randomized Androgen Deprivation and Radiotherapy 03/04 (RADAR; 2003-2007) randomized clinical trial (RCT); and a cross-trial comparison of the RADAR vs the Deprivación Androgénica y Radio Terapía (Androgen Deprivation and Radiation Therapy; DART) 01/05 RCT (2005-2010). In all, the study analyzed 1827 patients treated with EBRT and 1108 patients treated with EBRT+BT from the retrospective cohort; 181 treated with EBRT and 203 with EBRT+BT from RADAR; and 91 patients treated with EBRT from DART. The study was conducted from October 15, 2020, to July 1, 2021, and the data analyses, from January 5 to June 15, 2021. Exposures High-dose EBRT or EBRT+BT for an ADT duration determined by patient-physician choice (retrospective) or by randomization (RCTs). Main Outcomes and Measures The primary outcome was DMFS; secondary outcome was overall survival (OS). Natural cubic spline analysis identified minimum thresholds (months). Results This cohort study of 3 studies totaling 3410 men (mean age [SD], 68 [62-74] years; race and ethnicity not collected) with high-risk prostate cancer found a significant interaction between the treatment type (EBRT vs EBRT+BT) and ADT duration (binned to This cohort study explores associations between the duration of androgen deprivation therapy and distant metastasis-free survival in men undergoing external beam radiotherapy with and without a brachytherapy boost for treatment of high-risk prostate cancer. |
| Databáze: | OpenAIRE |
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