Duration of Androgen Deprivation in Locally Advanced Prostate Cancer: Long-Term Update of NRG Oncology RTOG 9202

Publication date: Available online 12 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Colleen A.F. Lawton, Xiaolei Lin, Gerald E. Hanks, Herbert Lepor, David J. Grignon, Harmar D. Brereton, Meena Bedi, Seth A. Rosenthal, Kenneth L. Zeitzer, Varagur M. Venkatesan, Eric M. Horwitz, Thomas M. Pisansky, Harold Kim, Matthew B. Parliament, Rachel Rabinovitch, Mack Roach, Young Kwok, James J. Dignam, Howard M. Sandler
PurposeTrial**** was a phase III randomized trial designed to determine the optimal duration of androgen deprivation therapy (ADT) when combined with definitive radiation therapy (RT) in the treatment of locally advanced non-metastatic adenocarcinoma of the prostate. Long-term follow-up results of this study now available are relevant to the management of this disease.Materials and MethodsMen (N=1,554) with adenocarcinoma of the prostate (cT2c-T4, N0-Nx) with a prostate specific antigen (PSA) <150ng/ml and no evidence of distant metastasis were randomized (June 1992 to April 1995) to short term ADT (STAD: 4 months of flutamide 250mg three times per day and goserelin 3.6mg per month) and definitive RT verses long term ADT (LTAD: STAD with definitive RT plus an additional 24 months of monthly goserelin).ResultsAmong 1,520 protocol eligible and evaluable patients, median follow up for this analysis was 19.6 years. In analysis adjusted for prognostic covariates, LTAD improved disease free survival (29% relative reduction in failure rate, p<0.0001), local progression (46% relative reduction, p=0.02), distant metastases (36% relative reduction, p<0.0001), disease specific survival (30% relative reduction, p=0.003), and overall survival (12% relative reduction, p=0.03). Other cause (non-prostate cancer) mortality did not differ (5% relative reduction, p=0.48).ConclusionsLTAD and RT is superior to STAD and RT for the treatment of locally advanced non-metastatic adenocarcinoma of the prostate and should be considered the standard of care.

Teaser

Several clinical trials have shown a benefit to adding androgen deprivation therapy (ADT) to definitive radiation therapy (RT) to treat locally advanced adenocarcinoma of the prostate. The length of time on ADT varied resulting in a question of the optimal timing. Trial**** addressed this question in a phase III randomized trial of RT and 4 months of ADT versus 28 months. Longer ADT was superior to shorter ADT.


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