Hormonal therapy and radiotherapy for localized prostate cancer: who, where and how long?
OBJECTIVE
The results from recent randomized trials were used to identify subpopulations of patients most likely to benefit from long versus short-term hormonal therapy with external beam radiotherapy.


METHODS
Radiation Therapy Oncology Group study 9413 included 1,323 men with prostate cancer and a risk of lymph node involvement greater than 15%. In this study the hypotheses tested were that whole pelvis radiotherapy would improve progression-free survival (PFS) compared to prostate only radiotherapy and that neoadjuvant and concurrent hormone therapy (N&CHT) with radiotherapy would improve PFS compared to radiotherapy with adjuvant hormone therapy. The conclusions of this study were compared to other studies using long-term hormonal therapy.


RESULTS
At a median followup of almost 5 years, when all 4 treatment arms from study 9413 were compared, the group receiving whole pelvis radiotherapy plus N&CHT had a significant PFS advantage (p = 0.008).


CONCLUSIONS
Intermediate risk patients should receive N&CHT in combination with external beam radiotherapy while high risk patients require the addition of long-term adjuvant hormone therapy.
Roach
Mack
M
Department of Radiation Oncology, University of California San Francisco, 94143-1708, USA. roach@radonc17.ucsf.edu
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis