UCLA Journal of Radiation Oncology January 1, 2022 - Flipbook - Page 36
UCLA RADIATION ONCOLOGY JOURNAL
duration of a course of radiation, part of
the hormone therapy will extend before
radiation begins (called neoadjuvant), and
part of it extends after the radiation has
completed (called adjuvant).
This analysis was conducted with data from
10,853 patients enrolled in 12 radiation
therapy trials to evaluate three aspects of
treatment:
•
Addition of androgen deprivation therapy
(ADT) to radiation therapy.
•
Prolongation of the adjuvant component
of ADT.
•
Prolongation of the neoadjuvant
component of ADT.
The primary objectives of the meta-analyses
were to evaluate the impact of these
interventions on metastasis-free survival
(MFS) and on overall survival (OS).
RESULTS
After a median follow-up of 12 years, the
addition of ADT to RT improved both 12year MFS and 12-year OS by 8% and 7%,
respectively. After a median follow-up of
10.9 years, prolongation of adjuvant ADT
improved both 12-year MFS and 12-year
OS by 7%. After a median follow-up of 10.3
years, prolongation of neoadjuvant ADT was
not associated with a significant benefit in
any endpoint.
ADT to at least 18 months in in conjunction
with definitive radiation therapy for the
treatment of localized prostate cancer. The
relative benefit of ADT use and adjuvant ADT
prolongation was consistent irrespective
of radiation dose escalation. In contrast,
prolonging neoadjuvant ADT beyond two
months did not improve survival outcomes.
MORE INFORMATION
For more information and to learn about
contributing data, please go to https://
marcap.one/.
AUTHORS
The first author and presenter is Dr. Amar
Kishan, associate professor and vice chair
of clinical and translational research at
UCLA. He also is chief of the Genitourinary
Oncology Service for the Department of
Radiation Oncology at the David Geffen
School of Medicine at UCLA and a member
of the UCLA Jonsson Comprehensive
Cancer Center. The co-founder of the
MARCAP consortium is Dr. Dan Spratt
from University Hospitals Seidman Cancer
Center. Additional authors represent UCLA,
University Hospitals, and other domestic and
international organizations and institutions.
JOURNAL/MEETING
Study results were presented at ASTRO 2021,
the annual meeting of the American Society
for Radiation Oncology, in Chicago. The
Additional findings from subgroup analyses: session title is 8 Individual Patient Data MetaAnalysis of Randomized Trials in Cancer of
There was no evidence of a treatment effect
the Prostate (MARCAP) Consortium: Impact
interaction between RT dose and the benefit
of Androgen Deprivation Therapy Use and
of ADT use or adjuvant ADT prolongation.
Duration With Definitive Radiotherapy for
Thus, the benefit of adding either ADT or
prolonging adjuvant ADT persists even if high Localized Prostate Cancer.
dose radiation is used, and even for patients
who have intermediate risk (rather than high
risk) disease.
CONCLUSIONS AND IMPACT
This study is believed to provide the
strongest evidence to date supporting use of
ADT as well as the prolongation of adjuvant
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