title: Addition of short-term androgen deprivation therapy to dose-escalated radiation therapy improves failure-free survival for select men with intermediate-risk prostate cancer.
abstract: BACKGROUND
  Dose-escalated (DE) radiation therapy (RT) and androgen deprivation therapy (ADT) improve prostate cancer outcomes over standard-dose RT. The benefit of adding ADT to DE-RT for men with intermediate-risk prostate cancer (IR-PrCa) is uncertain.
  
  
  METHODS
  We identified 636 men treated for IR-PrCa with DE-RT (>75Gy). The adult comorbidity evaluation-27 index classifed comorbidity. Kaplan-Meier and log-rank tests compared failure-free survival (FFS) with and without ADT.
  
  
  RESULTS
  Forty-five percent received DE-RT and 55% DE-RT with ADT (median 6 months). On Cox proportional hazard regression that adjusted for comorbidity and tumor characteristics, ADT improved FFS (adjusted hazard ratio 0.36; P = 0.004). Recursive partitioning analysis of men without ADT classified Gleason 4 + 3 = 7 or ≥50% positive cores as unfavorable disease. The addition of ADT to DE-RT improved 5-year FFS for men with unfavorable disease (81.6% versus 92.9%; P = 0.009) but did not improve FFS for men with favorable disease (96.3% versus 97.4%; P = 0.874). When stratified by comorbidity, ADT improved FFS for men with unfavorable disease and no or mild comorbidity (P = 0.006) but did not improve FFS for men with unfavorable disease and moderate or severe comorbidity (P = 0.380).
  
  
  CONCLUSIONS
  The addition of ADT to DE-RT improves FFS for men with unfavorable IR-PrCa, especially those with no or minimal comorbidity.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston; Baylor College of Medicine, Houston.
authors.forename: S X
authors.initials: SX
authors.lastname: Bian
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: D A
authors.initials: DA
authors.lastname: Kuban
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: L B
authors.initials: LB
authors.lastname: Levy
authors.affiliation: Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: J
authors.initials: J
authors.lastname: Oh
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: K O
authors.initials: KO
authors.lastname: Castle
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: T J
authors.initials: TJ
authors.lastname: Pugh
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: S
authors.initials: S
authors.lastname: Choi
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: S E
authors.initials: SE
authors.lastname: McGuire
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Q N
authors.initials: QN
authors.lastname: Nguyen
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: S J
authors.initials: SJ
authors.lastname: Frank
authors.affiliation: Department of Radiation Oncology, Dana Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, USA.
authors.forename: P L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: A K
authors.initials: AK
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston. Electronic address: khoffman1@mdanderson.org.
authors.forename: K E
authors.initials: KE
authors.lastname: Hoffman
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015897:Comorbidity; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009376:Neoplasms, Hormone-Dependent / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D000970:Antineoplastic Agents