Weighing the Addition of Androgen Suppression Therapy to Radiotherapy Dose Escalation for Intermediate-Risk Prostate Cancer
Mené sur 819 patients atteints d'un cancer de la prostate de stade cT1b-c sans signe clinique de métastase (âge médian : 70 ans ; durée médiane de suivi : 7,2 ans ; niveau du PSA : supérieur ou égal à 10ng/ml ; score de Gleason : supérieur ou égal à 7), cet essai évalue, du point de vue de la survie sans maladie biochimique, l'intérêt de combiner de manière concomitante une radiothérapie et un traitement anti-androgénique de courte durée
Men with intermediate-risk prostate cancer have a number of treatment options. These include external-beam radiation therapy (EBRT) alone and EBRT combined with short-term androgen suppression therapy (AST), among others such as brachytherapy and prostatectomy. When EBRT is the selected primary treatment option, short-term AST for 4 to 6 months should be strongly considered1 because the data supporting its use are overwhelmingly positive. The Harvard study reported by D’Amico et al2 and the Radiation Therapy Oncology Group (RTOG; now part of NRG Oncology) trial 9408 reported by Jones et al3 both randomly assigned intermediate-risk men between EBRT alone or EBRT plus 6 or 4 months of short-term AST beginning 2 months prior to the start of EBRT; both showed a survival benefit in the short-term AST arms. In addition, there is no evidence that short-term AST longer than 4 months confers additional benefit in patients with intermediate-risk prostate cancer. In the RTOG 9910 trial, Pisansky et al4 compared 4 months of short-term AST with 9 months of intermediate-term AST (7 months of neoadjuvant and 2 months of concurrent AST with EBRT) in 1,579 men who were randomly assigned to treatment. These investigators found no difference in the primary end point of cause-specific survival or in other end points, including biochemical-based end points. All of these trials involved relatively low total doses of EBRT, termed standard-dose EBRT, of 66 to 70 Gy in standard fractionation of 1.8 to 2.0 Gy per day. Level I evidence supports the use of 4 months of AST with standard doses of EBRT for men with intermediate-risk prostate cancer.
Journal of Clinical Oncology , éditorial en libre accès, 2016