title: Impact of hormonal treatment duration in combination with radiotherapy for locally advanced prostate cancer: meta-analysis of randomized trials.
abstract: BACKGROUND
  Hormone therapy plus radiotherapy significantly decreases recurrences and mortality of patients affected by locally advanced prostate cancer. In order to determine if difference exists according to the hormonal treatment duration, a literature-based meta-analysis was performed.
  
  
  METHODS
  Relative risks (RR) were derived through a random-effect model. Differences in primary (biochemical failure, BF; cancer-specific survival, CSS), and secondary outcomes (overall survival, OS; local or distant recurrence, LR/DM) were explored. Absolute differences (AD) and the number needed to treat (NNT) were calculated. Heterogeneity, a meta-regression for clinic-pathological predictors and a correlation test for surrogates were conducted.
  
  
  RESULTS
  Five trials (3,424 patients) were included. Patient population ranged from 267 to 1,521 patients. The longer hormonal treatment significantly improves BF (with significant heterogeneity) with an absolute benefit of 10.1%, and a non significant trend in CSS. With regard to secondary end-points, the longer hormonal treatment significantly decrease both the LR and the DM with an absolute difference of 11.7% and 11.5%. Any significant difference in OS was observed. None of the three identified clinico-pathological predictors (median PSA, range 9.5-20.35, Gleason score 7-10, 27-55% patients/trial, and T3-4, 13-77% patients/trial), did significantly affect outcomes. At the meta-regression analysis a significant correlation between the overall treatment benefit in BF, CSS, OS, LR and DM, and the length of the treatment was found (p ≤ 0.03).
  
  
  CONCLUSIONS
  Although with significant heterogeneity (reflecting different patient' risk stratifications), a longer hormonal treatment duration significantly decreases biochemical, local and distant recurrences, with a trend for longer cancer specific survival.
authors.affiliation: Department of Medical Oncology, Regina Elena National Cancer Institute, Roma, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Cuppone
authors.forename: Emilio
authors.initials: E
authors.lastname: Bria
authors.forename: Diana
authors.initials: D
authors.lastname: Giannarelli
authors.forename: Vanja
authors.initials: V
authors.lastname: Vaccaro
authors.forename: Michele
authors.initials: M
authors.lastname: Milella
authors.forename: Cecilia
authors.initials: C
authors.lastname: Nisticò
authors.forename: Enzo Maria
authors.initials: EM
authors.lastname: Ruggeri
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.forename: Sergio
authors.initials: S
authors.lastname: Bracarda
authors.forename: Paola
authors.initials: P
authors.lastname: Pinnarò
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lanzetta
authors.forename: Paola
authors.initials: P
authors.lastname: Muti
authors.forename: Francesco
authors.initials: F
authors.lastname: Cognetti
authors.forename: Paolo
authors.initials: P
authors.lastname: Carlini
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal