For locally advanced prostate cancer, adding radiotherapy to androgen-deprivation therapy significantly improves survival and exerts “only modest and transient negative impact” on health-related quality of life, according to a report published online May 26 in the Journal of Clinical Oncology.
In a nonblinded international clinical trial, 1,205 men with locally advanced prostate cancer were randomly assigned to receive either lifelong androgen-deprivation therapy alone (602 patients) or ADT plus radiotherapy (603 patients). Health-related quality of life (QOL) was assessed at 6-month intervals for 2 years and annually thereafter for up to 4 years, using either the European Organisation for Research and Treatment of Cancer core questionnaire plus a prostate cancer–specific checklist (EORTC QLQ-30) or the Functional Assessment of Cancer Therapy-Prostate questionnaire (FACT-P), said Dr. Michael Brundage of Queen’s Cancer Research Institute and the Cancer Centre of Southeastern Ontario, Kingston, and his associates.
Additive radiotherapy produced bowel symptoms and diarrhea and adversely affected urinary function and erectile function, but these effects receded over time and were no longer evident at 2 years. This pattern is consistent with the known toxicity of radiotherapy. Moreover, the proportion of men reporting severe bowel or bladder symptoms at any time was only slightly higher (less than 5% higher) in the radiotherapy group than in the ADT-only group. In contrast, urinary symptoms improved in many men in both treatment groups and overall survival was significantly higher with the addition of radiotherapy, the investigators said (J. Clin. Oncol. 2015 May 25 [doi:10.1200/JCO.2014.57.8724]).
“The adverse impact of radiotherapy overall was modest and temporary and, in our view, not of sufficient magnitude to offset the clear disease-specific and overall survival benefits conferred by curative RT in this setting,” Dr. Brundage and his associates wrote.
They added that treatment has changed somewhat since this study was conducted. Currently, ADT is how administered for a shorter period, rather than the lifelong duration of treatment that was standard practice at that time. In addition, radiotherapy techniques used in the study were “relatively crude” and prescribed doses were lower, compared with current practice, they noted.
This study was supported by the Canadian Cancer Society Research Institute, the U.S. National Cancer Institute, and the United Kingdom Medical Research Council. Dr. Brundage reported having no financial disclosures; two of his associates reported ties to Astellas, Eli Lilly, Janssen-Cilag, Novartis, Pfizer, Dendreon, Ferring Pharmaceuticals, and Sanofi.