학술논문
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
Document Type
article
Author
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; Romero, Tahmineh
Source
JAMA Oncology. 8(3)
Subject
Language
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