ADT + Pelvic Lymph Node Radiation Improves Prostate Cancer Outcomes
Five-year freedom from progression rate higher for those receiving short-term ADT and PLNRT in addition to salvage PBRT
THURSDAY, June 9, 2022 (HealthDay News) -- The addition of androgen deprivation therapy (ADT) and pelvic lymph node radiotherapy (PLNRT) to prostate bed radiotherapy (PBRT) prolongs freedom from progression of prostate cancer following prostatectomy, according to a study published in the May 14 issue of The Lancet.
Alan Pollack, M.D., from the University of Miami Miller School of Medicine, and colleagues conducted an international randomized trial involving patients with a persistently detectable or an initially undetectable and rising prostate-specific antigen of 0.1 to 2.0 ng/mL after prostatectomy for adenocarcinoma of the prostate. A total of 1,792 patients were enrolled and randomly assigned to PBRT alone (group 1), PBRT plus short-term ADT (group 2), or PLNRT plus PBRT and short-term ADT (group 3; 592, 602, and 598 patients, respectively). The evaluable patient population included 1,716 patients.
The researchers found that at the interim analysis, when group 1 was compared to group 3, the Haybittle-Peto boundary for five-year freedom from progression was exceeded (difference, 17.9 percent). Comparing groups 2 and 3, the difference did not exceed the boundary. At a median follow-up of 8.2 years, which was beyond the interim analysis, the five-year freedom from progression rates were 70.9, 81.3, and 87.4 percent in groups 1, 2, and 3, respectively. Freedom from progression was superior in group 3 versus groups 1 and 2 per protocol criteria.
"Extension of the standard postprostatectomy salvage prostate bed radiotherapy fields to include the pelvic lymph nodes, when used in combination with short-term ADT, was found to result in the greatest impact on outcomes," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
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