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Addition of hormone therapy to radiation therapy improved OS in patients with prostate cancer
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51st ASTRO Annual Meeting
Short-term hormone therapy — specifically androgen deprivation therapy — given prior to and during radiation treatment improved ten-year survival from 57% to 62% in patients with intermediate-risk prostate cancer.
At the 51st ASTRO Annual Meeting, Christopher U. Jones, MD, radiation oncologist at Radiological Associates of Sacramento, Calif., presented findings from a phase-3 trial conducted to compare the survival benefit of short-term hormone therapy added to radiation therapy vs. radiation therapy alone.
“Prior to this trial, it was unclear whether combining hormone therapy with radiation for intermediate-risk prostate cancer patients improves survival,” Jones said during a press conference.
From October 1994 to April 2001, researchers from the Radiology Therapy Oncology Group randomly assigned 987 patients to hormone therapy two months prior to and two months during radiation therapy and 992 patients to radiation therapy alone. All participating men had PSA less than 20.
“This study provides strong scientific evidence that shows us when to deliver hormone therapy with radiation in patients with localized prostate cancer,” Jones said in a press release.
“Our findings show that men with low-risk disease, which is the vast majority of prostate cancer patients, have little to gain from adding hormone therapy to radiation; however, men with intermediate disease, which is a significant minority of patients, gain a benefit in OS from the addition of only four months of hormone therapy,” he said.
In future studies, the Radiation Therapy Oncology Group will study whether intermediate-risk patients treated with modern radiation techniques continue to benefit from the addition of short-term hormone therapy, according to Jones. – by Christen Haigh
This is one of several other prior randomized studies that has shown an OS benefit to short-course hormonal therapy in select patients with prostate cancer. Although the total dose of radiation used in this study is low by today's standards, the fact that only four months of hormone therapy was able to confer an OS benefit is striking. To my knowledge, no randomized trial for escalating radiation dose in prostate cancer has demonstrated an actual OS benefit, but several studies have shown this benefit when short-course hormone therapy was used. Although the magnitude of this survival benefit may seem modest (~5%), this is the same magnitude of benefit that has justified the use of adjuvant systemic therapy for select patients with early stage breast cancer.
Clinicians should wait for the final manuscript, but given that other studies have shown a similar benefit, the judicious use of short-course hormone therapy in select patients with intermediate-risk prostate cancer needs to be considered. At minimum, physicians need to discuss with their patients the potential benefit of adding hormone therapy to radiation therapy. It also begs the question of whether consideration should be given to adopting lower doses of radiation if hormone therapy is used.
Retrospective studies have not universally shown that hormone therapy can always make up for more modest radiation doses, but this should be formally studied. Four months of hormone therapy in select patients with localized prostate cancer may improve clinical outcomes including OS. Ideally, a randomized trial of higher doses of radiation with or without hormone therapy should be done and is underway.
– Andrew Lee, MD, MPH
Associate Professor, Department of Radiation Oncology, MD Anderson Cancer Center, Houston
For more information:
- Jones CU. Short-term endocrine therapy prior to and during radiation therapy improves overall survival in patients with T1b-T2b adenocarcinoma of the prostate and PSA ≤20: Initial results of RTOG 94-08. Presented at: 51st ASTRO Annual Meeting; Nov. 1-5, 2009, Chicago.
