Androgen deprivation therapy combined with postoperative radiotherapy for prostate cancer management
Ce dossier présente les résultats d'un essai randomisé international de phase III évaluant l'efficacité, du point de vue de la survie sans métastase, et la durée d'une thérapie anti-androgénique combinée à une radiothérapie postopératoire chez des patients atteints d'un cancer de la prostate localisé à risque intermédiaire ou élevé de récidive (âge médian : 65 ans ; durée médiane de suivi : 9 ans)
Androgen deprivation therapy (ADT) is a mainstay of treatment management with radiotherapy for prostate cancer, 1 including for men treated for salvage after prostatectomy. Three major randomised trials have been conducted previously: RTOG 9601, GETUG-AFU 16, and NRG Oncology/RTOG 0534 SPPORT (hereafter referred to as SPPORT); 2 , 3 , 4 the addition of RADICALS-HD is a substantial extension of these results with the notable differences of including post-prostatectomy patients receiving adjuvant and salvage treatment, and using metastasis-free survival as the primary endpoint (9 years median follow-up). In The Lancet, two Articles by Parker and colleagues describe the results of the phase 3 RADICALS-HD trial, the first comparing no ADT (n=737) to short-course ADT (6 months; n=743) 5 and the other comparing short-course ADT (n=761) to long-course ADT (24 months; n=762). 6 The RADICALS trial has a complex design that includes the RADICALS-HD components and the previously published RADICALS-RT 7 component in which adjuvant radiotherapy (before evidence of biochemical progression by prostate-specific antigen [PSA] monitoring) was compared with observation with early salvage radiotherapy for PSA (biochemical) progression. RADICALS-RT previously established that prostate bed radiotherapy after prostatectomy in most cases should be delayed until the PSA increases and early salvage radiotherapy administered. Whereas the RADICALS-RT portion has been practice changing, it is less clear how clinical practice will be affected by the RADICALS-HD components, based on interpretation of the primary endpoint of metastasis-free survival and the secondary endpoints of clinical progression and administration of ADT for salvage after completion of protocol treatment (secondary salvage ADT).