Ten-Year Follow-Up of Radiation Therapy Oncology Group Protocol 92-02: A Phase III Trial of the Duration of Elective Androgen Deprivation in Locally Advanced Prostate Cancer

Horwitz, Eric M.; Bae, Kyounghwa; Hanks, Gerald E.; Porter, Arthur T.; Grignon, David J.; Brereton, Harmar D.; Venkatesan, Varagur; Lawton, Colleen A.; Rosenthal, Seth A.; Sandler, Howard M.; Shipley, William U.

doi:10.1200/jco.2007.14.9021

Cited by 634 publications

(446 citation statements)

References 17 publications

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“…This trial demonstrated a significant increase in late Grade 3 and higher toxicity associated with RT and LTAD (p = 0.037). Grade 3 or higher GI toxicity was 10% for STAD and 25% for LTAD (6,7).…”

Section: Discussionmentioning

confidence: 99%

“…The addition of androgen deprivation (AD) therapy to 3DCRT for intermediate and highrisk prostate cancer has been shown to improve in local control, biochemical-free survival, distant metastases and overall survival (5)(6)(7)(8). Some studies have suggested that the addition of AD increases the risk of GI and GU toxicity while others have not (7,(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…Some studies have suggested that the addition of AD increases the risk of GI and GU toxicity while others have not (7,(9)(10)(11). At Fox Chase Cancer Center, our experience is that the addition of long-term AD (LTAD) significantly increases grade 2 and higher GI and GU toxicity with in patients treated with 3DCRT for locally advanced prostate cancer (9).…”

Section: Introductionmentioning

confidence: 99%

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Intensity Modulated Radiation Therapy Reduces Gastrointestinal Morbidity in Patients Treated With Androgen Deprivation Therapy for Prostate Cancer

Sharma

Chen

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Purpose-Androgen deprivation therapy (AD) has been shown to increase late ≥ grade 2 rectal toxicity when used concurrently with three-dimensional conformal radiotherapy (3DCRT). Intensity modulated radiotherapy (IMRT) has the potential to reduce toxicity by limiting the radiation dose received by the bowel and bladder. This study compares both genitourinary (GU) and gastrointestinal (GI) toxicity in men treated with 3DCRT+AD versus IMRT+AD.Methods and Materials-From July 1992 to July 2004, 293 men received 3DCRT (n=170) or IMRT (n=123) with concurrent AD (< 6 months, n=123; ≥ 6 months, n =170). Median RT doses were 76 Gy for 3DCRT (ICRU) and 76 Gy for IMRT (95% to the PTV). Toxicity was assessed by a patient symptom questionnaire assessing toxicity completed at each visit and recorded using a modified late effects normal tissue task force radiation morbidity scale (LENT).Results-Mean follow-up was 86 months (SD=29.3) for the 3DCRT group and 40 months (SD=9.7) for the IMRT group. Acute GI toxicity (OR=4, 95% CI: 1.6-11.7, p=0.005) was significantly higher with 3DCRT than with IMRT and was independent of AD duration (i.e. <6 vs. ≥6 months). Time to development of late GI toxicity was significantly longer in the IMRT group. The 5-year Kaplan-Meier estimates for ≥ grade 2 GI toxicity were 20% for 3DCRT versus 8% for IMRT (p=0.01). On MVA, ≥ grade 2 late GI toxicity (HR=2.1, 95% CI: 1.1-4.3, p=0.04) was more prevalent in 3DCRT patients. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-Compared to 3DCRT, IMRT significantly decreased acute and late GI toxicity in patients treated with AD. NIH Public Access

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intensity Modulated Radiation Therapy Reduces Gastrointestinal Morbidity in Patients Treated With Androgen Deprivation Therapy for Prostate Cancer

Sharma

Chen

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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“…Original Article RTOG 92-02 9 and was calibrated to result in survival estimates comparable to data in the reported literature. We assumed that the rate of metastasis as first failure was constant over the 10 years of follow-up.…”

Section: Patterns Of Failure and Mortalitymentioning

confidence: 99%

Primary radiotherapy versus radical prostatectomy for high‐risk prostate cancer

Parikh

Sher

2011

Cancer

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BACKGROUND: Two evidence-based therapies exist for the treatment of high-risk prostate cancer (PCA): externalbeam radiotherapy (RT) with hormone therapy (H) (RT þ H) and radical prostatectomy (S) with adjuvant radiotherapy (S þ RT). Each of these strategies is associated with different rates of local control, distant metastasis (DM), and toxicity. By using decision analysis, the authors of this report compared the quality-adjusted life expectancy (QALE) between men with high-risk PCA who received RT þ H versus S þ RT versus a hypothetical trimodality therapy (S þ RT þ H). METHODS: The authors developed a Markov model to describe lifetime health states after treatment for high-risk PCA. Probabilities and utilities were extrapolated from the literature. Toxicities after radiotherapy were based on intensity-modulated radiotherapy series, and patients were exposed to risks of diabetes, cardiovascular disease, and fracture for 5 years after completing H. Deterministic and probabilistic sensitivity analyses were performed to model uncertainty in outcome rates, toxicities, and utilities. RESULTS: RT þ H resulted in a higher QALE compared with S þ RT over a wide range of assumptions, nearly always resulting in an increase of >1 quality-adjusted life year with outcomes highly sensitive to the risk of increased all-cause mortality from H. S þ RT þ H typically was superior to RT þ H, albeit by small margins (<0.5 quality-adjusted life year), with results sensitive to assumptions about toxicity and radiotherapy efficacy. CONCLUSIONS: For men with high-risk PCA, RT þ H was superior to S þ RT, and the result was sensitive to the risk of all-cause mortality from H. Moreover, trimodality therapy may offer local and distant control benefits that lead to optimal outcomes in a meaningful population of men. Cancer 2012;118:258-

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“…The optimal duration of ADT in men undergoing RT has been addressed in at least four trials, all of which suggest benefit from prolonged therapy [47,[53][54][55][56]. For example, in the largest trial, RTOG 92-02, 1,554 men with T2c-T4 disease received 4 months of goserelin and flutamide (2 months before and during EBRT) and were then randomly assigned to no further therapy or 24 months of additional goserelin.…”

Section: How Long Should Abiraterone Acetate Be Continued After Progrmentioning

confidence: 99%

Beyond Castration—Defining Future Directions in the Hormonal Treatment of Prostate Cancer

Niraula¹,

N.²,

Joshua³

2011

HORM CANC

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It is now almost 70 years since Charles Huggins described the relationship between testosterone and the prostate gland. Arguably defining one of the first targeted therapies, the reduction of testosterone to castrate levels remains unaltered as the standard of care for men with metastatic prostate cancer. The failure of castration to permanently control the growth of prostate cancer leads to a state called castration-resistant prostate cancer (CRPC).

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Ten-Year Follow-Up of Radiation Therapy Oncology Group Protocol 92-02: A Phase III Trial of the Duration of Elective Androgen Deprivation in Locally Advanced Prostate Cancer

Cited by 634 publications

References 17 publications

Intensity Modulated Radiation Therapy Reduces Gastrointestinal Morbidity in Patients Treated With Androgen Deprivation Therapy for Prostate Cancer

Intensity Modulated Radiation Therapy Reduces Gastrointestinal Morbidity in Patients Treated With Androgen Deprivation Therapy for Prostate Cancer

Primary radiotherapy versus radical prostatectomy for high‐risk prostate cancer

Beyond Castration—Defining Future Directions in the Hormonal Treatment of Prostate Cancer

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