1. 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
- Author
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Kishan, Amar U, Steigler, Alison, Denham, James W, Zapatero, Almudena, Guerrero, Araceli, Joseph, David, Maldonado, Xavier, Wong, Jessica K, Stish, Bradley J, Dess, Robert T, Pilar, Avinash, Reddy, Chandana, Wedde, Trude B, Lilleby, Wolfgang A, Fiano, Ryan, Merrick, Gregory S, Stock, Richard G, Demanes, D Jeffrey, Moran, Brian J, Tran, Phuoc T, Martin, Santiago, Martinez-Monge, Rafael, Krauss, Daniel J, Abu-Isa, Eyad I, Pisansky, Thomas M, Choo, C Richard, Song, Daniel Y, Greco, Stephen, Deville, Curtiland, McNutt, Todd, DeWeese, Theodore L, Ross, Ashley E, Ciezki, Jay P, Tilki, Derya, Karnes, R Jeffrey, Tosoian, Jeffrey J, Nickols, Nicholas G, Bhat, Prashant, Shabsovich, David, Juarez, Jesus E, Jiang, Tommy, Ma, T Martin, Xiang, Michael, Philipson, Rebecca, Chang, Albert, Kupelian, Patrick A, Rettig, Matthew B, Feng, Felix Y, Berlin, Alejandro, Tward, Jonathan D, Davis, Brian J, Reiter, Robert E, Steinberg, Michael L, Elashoff, David, Boutros, Paul C, Horwitz, Eric M, Tendulkar, Rahul D, Spratt, Daniel E, and Romero, Tahmineh
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Clinical Trials and Supportive Activities ,Cancer ,Radiation Oncology ,Clinical Research ,Aging ,Prostate Cancer ,Urologic Diseases ,6.1 Pharmaceuticals ,Androgen Antagonists ,Androgens ,Brachytherapy ,Data Analysis ,Humans ,Male ,Middle Aged ,Prostatic Neoplasms ,Retrospective Studies ,Public Health and Health Services ,Oncology and carcinogenesis - Abstract
ImportanceRadiotherapy 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.ObjectiveTo 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 participantsThis 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.ExposuresHigh-dose EBRT or EBRT+BT for an ADT duration determined by patient-physician choice (retrospective) or by randomization (RCTs).Main outcomes and measuresThe primary outcome was DMFS; secondary outcome was overall survival (OS). Natural cubic spline analysis identified minimum thresholds (months).ResultsThis 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
- Published
- 2022