Dose-Escalated Radiotherapy Alone or in Combination with Short-Term Androgen Deprivation for Intermediate-Risk Prostate Cancer: Results of a Phase III Multi-Institutional Trial

Daniel J. Krauss, Theodore Karrison, Alvaro A. Martinez, Gerard Morton, Di Yan, Deborah Watkins Bruner, Benjamin Movsas, Mohamed Elshaikh, Deborah Citrin, Bruce Hershatter, Jeff M. Michalski, Jason Alexander Efstathiou, Adam Currey, Vivek S. Kavadi, Fabio L. Cury, Michael Lock, Adam Raben, Samantha Andrews Seaward, Ali El-Gayed, Joseph P. RodgersHoward M. Sandler

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

PURPOSEIt remains unknown whether or not short-term androgen deprivation (STAD) improves survival among men with intermediate-risk prostate cancer (IRPC) treated with dose-escalated radiotherapy (RT).METHODSThe NRG Oncology/Radiation Therapy Oncology Group 0815 study randomly assigned 1,492 patients with stage T2b-T2c, Gleason score 7, or prostate-specific antigen (PSA) value >10 and 20 ng/mL to dose-escalated RT alone (arm 1) or with STAD (arm 2). STAD was 6 months of luteinizing hormoneareleasing hormone agonist/antagonist therapy plus antiandrogen. RT modalities were external-beam RT alone to 79.2 Gy or external beam (45 Gy) with brachytherapy boost. The primary end point was overall survival (OS). Secondary end points included prostate cancer mortality (PCSM), non-PCSM, distant metastases (DMs), PSA failure, and rates of salvage therapy.RESULTSMedian follow-up was 6.3 years. Two hundred nineteen deaths occurred, 119 in arm 1 and 100 in arm 2. Five-year OS estimates were 90% versus 91%, respectively (hazard ratio [HR], 0.85; 95% CI, 0.65 to 1.11]; P =.22). STAD resulted in reduced PSA failure (HR, 0.52; P <.001), DM (HR, 0.25; P <.001), PCSM (HR, 0.10; P =.007), and salvage therapy use (HR, 0.62; P =.025). Other-cause deaths were not significantly different (P =.56). Acute grade 3 adverse events (AEs) occurred in 2% of patients in arm 1 and in 12% for arm 2 (P <.001). Cumulative incidence of late grade 3 AEs was 14% in arm 1 and 15% in arm 2 (P =.29).CONCLUSIONSTAD did not improve OS rates for men with IRPC treated with dose-escalated RT. Improvements in metastases rates, prostate cancer deaths, and PSA failures should be weighed against the risk of adverse events and the impact of STAD on quality of life.

Original languageEnglish
Pages (from-to)3203-3216
Number of pages14
JournalJournal of Clinical Oncology
Volume41
Issue number17
DOIs
StatePublished - Jun 10 2023

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