Display options
Cite
Jiang T, Markovic D, Patel J, et al. Radiation therapy dose and androgen deprivation therapy in localized prostate cancer: a meta-regression of 5-year outcomes in phase III randomized controlled trials. Prostate Cancer Prostatic Dis. 2021;doi: 10.1038/s41391-021-00432-2.
Jiang, T., Markovic, D., Patel, J., Juarez, J. E., Ma, T. M., Shabsovich, D., Nickols, N. G., Reiter, R. E., Elashoff, D., Rettig, M. B., Zaorsky, N. G., Spratt, D. E., & Kishan, A. U. (2021). Radiation therapy dose and androgen deprivation therapy in localized prostate cancer: a meta-regression of 5-year outcomes in phase III randomized controlled trials. Prostate cancer and prostatic diseases, . https://doi.org/10.1038/s41391-021-00432-2
Jiang, Tommy, et al. "Radiation therapy dose and androgen deprivation therapy in localized prostate cancer: a meta-regression of 5-year outcomes in phase III randomized controlled trials." Prostate cancer and prostatic diseases vol. (2021). doi: https://doi.org/10.1038/s41391-021-00432-2
Jiang T, Markovic D, Patel J, Juarez JE, Ma TM, Shabsovich D, Nickols NG, Reiter RE, Elashoff D, Rettig MB, Zaorsky NG, Spratt DE, Kishan AU. Radiation therapy dose and androgen deprivation therapy in localized prostate cancer: a meta-regression of 5-year outcomes in phase III randomized controlled trials. Prostate Cancer Prostatic Dis. 2021 Aug 16; doi: 10.1038/s41391-021-00432-2. Epub 2021 Aug 16. PMID: 34400799.
Copy Download .nbib Format: NLM
Share it on

Prostate Cancer Prostatic Dis. 2021 Aug 16; doi: 10.1038/s41391-021-00432-2. Epub 2021 Aug 16.

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

Prostate cancer and prostatic diseases

Tommy Jiang, Daniela Markovic, Jay Patel, Jesus E Juarez, Ting Martin Ma, David Shabsovich, Nicholas G Nickols, Robert E Reiter, David Elashoff, Matthew B Rettig, Nicholas G Zaorsky, Daniel E Spratt, Amar U Kishan

Affiliations

  1. Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
  2. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
  3. Department of Medicine, Statistics Core, University of California, Los Angeles, CA, USA.
  4. Division of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
  5. Division of Hematology and Oncology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
  6. Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA.
  7. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
  8. Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. [email protected].
  9. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. [email protected].

PMID: 34400799 DOI: 10.1038/s41391-021-00432-2

Abstract

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).

References

  1. Spratt DE, Michalski JM. Long-term benefits of dose-escalation in localized prostate cancer. Int J Radiat Oncol Biol Phys. 2019;104:798–800. - PubMed
  2. Nguyen PL. Optimization of the radiation management of high-risk prostate cancer. Semin Radiat Oncol. 2017;27:43–9. - PubMed
  3. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. - PubMed
  4. Trinquart L, Jacot J, Conner SC, Porcher R. Comparison of treatment effects measured by the hazard ratio and by the ratio of restricted mean survival times in oncology randomized controlled trials. J Clin Oncol. 2016;34:1813–9. - PubMed
  5. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88. - PubMed
  6. Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017;71:618–29. - PubMed
  7. Polkinghorn WR, Parker JS, Lee MX, Kass EM, Spratt DE, Iaquinta PJ, et al. Androgen receptor signaling regulates DNA repair in prostate cancers. Cancer Discov. 2013;3:1245–53. - PubMed
  8. Kishan AU, Chu FI, King CR, Seiferheld W, Spratt DE, Tran P, et al. Local failure and survival after definitive radiotherapy for aggressive prostate cancer: an individual patient-level meta-analysis of six randomized trials. Eur Urol. 2020;77:201–8. - PubMed

Publication Types