Details

Autor(en) / Beteiligte

• Ma, Ting Martin
• Sun, Yilun
• Malone, Shawn
• Roach, 3rd, Mack
• Dearnaley, David
• Pisansky, Thomas M
• Feng, Felix Y
• Sandler, Howard M
• Efstathiou, Jason A
• Syndikus, Isabel
• Hall, Emma C
• Tree, Alison C
• Sydes, Matthew R
• Cruickshank, Claire
• Roy, Soumyajit
• Bolla, Michel
• Maingon, Philippe
• De Reijke, Theo
• Nabid, Abdenour
• Carrier, Nathalie
• Souhami, Luis
• Zapatero, Almudena
• Guerrero, Araceli
• Alvarez, Ana
• Gonzalez San-Segundo, Carmen
• Maldonado, Xavier
• Romero, Tahmineh
• Steinberg, Michael L
• Valle, Luca F
• Rettig, Matthew B
• Nickols, Nicholas G
• Shoag, Jonathan E
• Reiter, Robert E
• Zaorsky, Nicholas G
• Jia, Angela Y
• Garcia, Jorge A
• Spratt, Daniel E
• Kishan, Amar U

Titel

Sequencing of Androgen-Deprivation Therapy of Short Duration With Radiotherapy for Nonmetastatic Prostate Cancer (SANDSTORM): A Pooled Analysis of 12 Randomized Trials

Ist Teil von

• Journal of clinical oncology, 2023-02, Vol.41 (4), p.881-892

Ort / Verlag

United States: Wolters Kluwer Health

Erscheinungsjahr

2023

Quelle

MEDLINE

Beschreibungen/Notizen

• The sequencing of androgen-deprivation therapy (ADT) with radiotherapy (RT) may affect outcomes for prostate cancer in an RT-field size-dependent manner. Herein, we investigate the impact of ADT sequencing for men receiving ADT with prostate-only RT (PORT) or whole-pelvis RT (WPRT). Individual patient data from 12 randomized trials that included patients receiving neoadjuvant/concurrent or concurrent/adjuvant short-term ADT (4-6 months) with RT for localized disease were obtained from the Meta-Analysis of Randomized trials in Cancer of the Prostate consortium. Inverse probability of treatment weighting (IPTW) was performed with propensity scores derived from age, initial prostate-specific antigen, Gleason score, T stage, RT dose, and mid-trial enrollment year. Metastasis-free survival (primary end point) and overall survival (OS) were assessed by IPTW-adjusted Cox regression models, analyzed independently for men receiving PORT versus WPRT. IPTW-adjusted Fine and Gray competing risk models were built to evaluate distant metastasis (DM) and prostate cancer-specific mortality. Overall, 7,409 patients were included (6,325 neoadjuvant/concurrent and 1,084 concurrent/adjuvant) with a median follow-up of 10.2 years (interquartile range, 7.2-14.9 years). A significant interaction between ADT sequencing and RT field size was observed for all end points ( interaction < .02 for all) except OS. With PORT (n = 4,355), compared with neoadjuvant/concurrent ADT, concurrent/adjuvant ADT was associated with improved metastasis-free survival (10-year benefit 8.0%, hazard ratio [HR], 0.65; 95% CI, 0.54 to 0.79; < .0001), DM (subdistribution HR, 0.52; 95% CI, 0.33 to 0.82; = .0046), prostate cancer-specific mortality (subdistribution HR, 0.30; 95% CI, 0.16 to 0.54; < .0001), and OS (HR, 0.69; 95% CI, 0.57 to 0.83; = .0001). However, in patients receiving WPRT (n = 3,049), no significant difference in any end point was observed in regard to ADT sequencing except for worse DM (HR, 1.57; 95% CI, 1.20 to 2.05; = .0009) with concurrent/adjuvant ADT. ADT sequencing exhibits a significant impact on clinical outcomes with a significant interaction with field size. Concurrent/adjuvant ADT should be the standard of care where short-term ADT is indicated in combination with PORT.