Duration of Androgen Deprivation in Locally Advanced Prostate Cancer

Long-Term Update of NRG Oncology RTOG 9202

Colleen A.F. Lawton, Xiaolei Lin, Gerald E. Hanks, Herbert Lepor, David Grignon, Harmar D. Brereton, Meena Bedi, Seth A. Rosenthal, Kenneth L. Zeitzer, Varagur M. Venkatesan, Eric M. Horwitz, Thomas M. Pisansky, Harold Kim, Matthew B. Parliament, Rachel Rabinovitch, Mack Roach, Young Kwok, James J. Dignam, Howard M. Sandler

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Purpose Trial RTOG 9202 was a phase 3 randomized trial designed to determine the optimal duration of androgen deprivation therapy (ADT) when combined with definitive radiation therapy (RT) in the treatment of locally advanced nonmetastatic adenocarcinoma of the prostate. Long-term follow-up results of this study now available are relevant to the management of this disease. Methods and Materials Men (N=1554) with adenocarcinoma of the prostate (cT2c-T4, N0-Nx) with a prostate-specific antigen (PSA) <150 ng/mL and no evidence of distant metastasis were randomized (June 1992 to April 1995) to short-term ADT (STAD: 4 months of flutamide 250 mg 3 times per day and goserelin 3.6 mg per month) and definitive RT versus long-term ADT (LTAD: STAD with definitive RT plus an additional 24 months of monthly goserelin). Results Among 1520 protocol-eligible and evaluable patients, the median follow-up time for this analysis was 19.6 years. In analysis adjusted for prognostic covariates, LTAD improved disease-free survival (29% relative reduction in failure rate, P<.0001), local progression (46% relative reduction, P=.02), distant metastases (36% relative reduction, P<.0001), disease-specific survival (30% relative reduction, P=.003), and overall survival (12% relative reduction, P=.03). Other-cause mortality (non–prostate cancer) did not differ (5% relative reduction, P=.48). Conclusions LTAD and RT is superior to STAD and RT for the treatment of locally advanced nonmetastatic adenocarcinoma of the prostate and should be considered the standard of care.

Original languageEnglish (US)
Pages (from-to)296-303
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume98
Issue number2
DOIs
StatePublished - Jun 1 2017

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deprivation
Androgens
Prostatic Neoplasms
Radiotherapy
cancer
radiation therapy
Goserelin
Prostate
Adenocarcinoma
therapy
metastasis
Neoplasm Metastasis
Flutamide
Therapeutics
Survival
Standard of Care
Prostate-Specific Antigen
Disease Management
mortality
Disease-Free Survival

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Duration of Androgen Deprivation in Locally Advanced Prostate Cancer : Long-Term Update of NRG Oncology RTOG 9202. / Lawton, Colleen A.F.; Lin, Xiaolei; Hanks, Gerald E.; Lepor, Herbert; Grignon, David; Brereton, Harmar D.; Bedi, Meena; Rosenthal, Seth A.; Zeitzer, Kenneth L.; Venkatesan, Varagur M.; Horwitz, Eric M.; Pisansky, Thomas M.; Kim, Harold; Parliament, Matthew B.; Rabinovitch, Rachel; Roach, Mack; Kwok, Young; Dignam, James J.; Sandler, Howard M.

In: International Journal of Radiation Oncology Biology Physics, Vol. 98, No. 2, 01.06.2017, p. 296-303.

Research output: Contribution to journalArticle

Lawton, CAF, Lin, X, Hanks, GE, Lepor, H, Grignon, D, Brereton, HD, Bedi, M, Rosenthal, SA, Zeitzer, KL, Venkatesan, VM, Horwitz, EM, Pisansky, TM, Kim, H, Parliament, MB, Rabinovitch, R, Roach, M, Kwok, Y, Dignam, JJ & Sandler, HM 2017, 'Duration of Androgen Deprivation in Locally Advanced Prostate Cancer: Long-Term Update of NRG Oncology RTOG 9202', International Journal of Radiation Oncology Biology Physics, vol. 98, no. 2, pp. 296-303. https://doi.org/10.1016/j.ijrobp.2017.02.004
Lawton, Colleen A.F. ; Lin, Xiaolei ; Hanks, Gerald E. ; Lepor, Herbert ; Grignon, David ; Brereton, Harmar D. ; Bedi, Meena ; Rosenthal, Seth A. ; Zeitzer, Kenneth L. ; Venkatesan, Varagur M. ; Horwitz, Eric M. ; Pisansky, Thomas M. ; Kim, Harold ; Parliament, Matthew B. ; Rabinovitch, Rachel ; Roach, Mack ; Kwok, Young ; Dignam, James J. ; Sandler, Howard M. / Duration of Androgen Deprivation in Locally Advanced Prostate Cancer : Long-Term Update of NRG Oncology RTOG 9202. In: International Journal of Radiation Oncology Biology Physics. 2017 ; Vol. 98, No. 2. pp. 296-303.
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abstract = "Purpose Trial RTOG 9202 was a phase 3 randomized trial designed to determine the optimal duration of androgen deprivation therapy (ADT) when combined with definitive radiation therapy (RT) in the treatment of locally advanced nonmetastatic adenocarcinoma of the prostate. Long-term follow-up results of this study now available are relevant to the management of this disease. Methods and Materials Men (N=1554) with adenocarcinoma of the prostate (cT2c-T4, N0-Nx) with a prostate-specific antigen (PSA) <150 ng/mL and no evidence of distant metastasis were randomized (June 1992 to April 1995) to short-term ADT (STAD: 4 months of flutamide 250 mg 3 times per day and goserelin 3.6 mg per month) and definitive RT versus long-term ADT (LTAD: STAD with definitive RT plus an additional 24 months of monthly goserelin). Results Among 1520 protocol-eligible and evaluable patients, the median follow-up time for this analysis was 19.6 years. In analysis adjusted for prognostic covariates, LTAD improved disease-free survival (29{\%} relative reduction in failure rate, P<.0001), local progression (46{\%} relative reduction, P=.02), distant metastases (36{\%} relative reduction, P<.0001), disease-specific survival (30{\%} relative reduction, P=.003), and overall survival (12{\%} relative reduction, P=.03). Other-cause mortality (non–prostate cancer) did not differ (5{\%} relative reduction, P=.48). Conclusions LTAD and RT is superior to STAD and RT for the treatment of locally advanced nonmetastatic adenocarcinoma of the prostate and should be considered the standard of care.",
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AU - Lawton, Colleen A.F.

AU - Lin, Xiaolei

AU - Hanks, Gerald E.

AU - Lepor, Herbert

AU - Grignon, David

AU - Brereton, Harmar D.

AU - Bedi, Meena

AU - Rosenthal, Seth A.

AU - Zeitzer, Kenneth L.

AU - Venkatesan, Varagur M.

AU - Horwitz, Eric M.

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AU - Kim, Harold

AU - Parliament, Matthew B.

AU - Rabinovitch, Rachel

AU - Roach, Mack

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AU - Dignam, James J.

AU - Sandler, Howard M.

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N2 - Purpose Trial RTOG 9202 was a phase 3 randomized trial designed to determine the optimal duration of androgen deprivation therapy (ADT) when combined with definitive radiation therapy (RT) in the treatment of locally advanced nonmetastatic adenocarcinoma of the prostate. Long-term follow-up results of this study now available are relevant to the management of this disease. Methods and Materials Men (N=1554) with adenocarcinoma of the prostate (cT2c-T4, N0-Nx) with a prostate-specific antigen (PSA) <150 ng/mL and no evidence of distant metastasis were randomized (June 1992 to April 1995) to short-term ADT (STAD: 4 months of flutamide 250 mg 3 times per day and goserelin 3.6 mg per month) and definitive RT versus long-term ADT (LTAD: STAD with definitive RT plus an additional 24 months of monthly goserelin). Results Among 1520 protocol-eligible and evaluable patients, the median follow-up time for this analysis was 19.6 years. In analysis adjusted for prognostic covariates, LTAD improved disease-free survival (29% relative reduction in failure rate, P<.0001), local progression (46% relative reduction, P=.02), distant metastases (36% relative reduction, P<.0001), disease-specific survival (30% relative reduction, P=.003), and overall survival (12% relative reduction, P=.03). Other-cause mortality (non–prostate cancer) did not differ (5% relative reduction, P=.48). Conclusions LTAD and RT is superior to STAD and RT for the treatment of locally advanced nonmetastatic adenocarcinoma of the prostate and should be considered the standard of care.

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