• Waldenström Macroglobulinemia
  • Melanoma
  • Bladder Cancer
  • Brain Cancer
  • Breast Cancer
  • Childhood Cancers
  • Gastric Cancer
  • Gynecologic Cancer
  • Head & Neck Cancer
  • Immunotherapy
  • Kidney Cancer
  • Leukemia
  • Liver Cancer
  • Lung Cancer
  • Lymphoma Cancer
  • Mesothelioma
  • MPN
  • MDS
  • Myeloma
  • Prostate Cancer
  • Rare Cancers
  • Sarcoma
  • Skin Cancer
  • Testicular Cancer
  • Thyroid Cancer

Long-Term, High-Dose Radiation, ADT Boosts Survival in Prostate Cancer

News
Article

Patients with high-risk prostate cancer who had a higher dose of radiation plus long-term androgen deprivation therapy tended to live longer than those who had a lower dose.

A higher dose of radiation plus long-term androgen deprivation therapy (ADT) improved long-time survival in patients with high-risk prostate cancer without causing significant decreases in quality of life, according to findings from the GETUG-AFU 18 trial presented at the 2024 ASCO Genitourinary Cancers Symposium.

“Even if we use a long-term ADT, high-dose radiotherapy improves progression-free survival, cancer-specific survival, and overall survival, compared to a (standard dose of) 70 Gy, in (patients with) high-risk prostate cancer without increasing toxicity,” Dr. Christophe Hennequin, Department of Radiation Oncology, Saint-Louis Hospital, Paris, said during a presentation of the data.

After a median follow-up of 114.2 months, the five-year biochemical or clinical progression-free survival (PFS; time from treatment until disease progression or death) rates in the 80 Gy (dose escalation) and 70 Gy (control) groups were 91.4% and 88.1%, respectively, while the 10-year rates were 83.6% and 72.2%. The dose-escalation of radiotherapy reduced the risk of disease progression by 44%.

Study Highlights:

  • Higher doses of radiation, combined with long-term androgen deprivation therapy (ADT), improved long-term survival in patients with high-risk prostate cancer without significant impacts on their quality of life.
  • The GETUG-AFU 18 trial revealed that the dose-escalation of radiotherapy to 80 Gy demonstrated better progression-free survival, cancer-specific survival and overall survival compared to the standard 70 Gy, reducing the risk for disease progression and death.
  • After a median follow-up of 114.2 months, the 80 Gy group showed higher five-year and 10-year rates for progression-free survival, cancer-specific survival, and overall survival, with a 44% reduction in the risk for disease progression.
  • There were no significant differences in toxicity and quality of life between the higher dose and standard dose arms of the trial, with both showing similar rates of late toxicities.
  • The study suggests that high-dose radiotherapy, particularly using intensity-modulated radiation therapy, in combination with long-term ADT should be considered the standard of care for high-risk prostate cancer patients.

When evaluating cancer-specific survival in the dose escalation and control groups, the five-year and 10-year rates continued to demonstrate superiority with the 80-Gy.

Lastly, the dose-escalation arm showed a five-year overall survival (OS; time from treatment until death of any cause) rate of 93.4%, compared with 88.7% with the control arm, as well as 10-year OS rates of 77.0% and 65.9%, respectively, reducing the risk of death by 39%.

Hennequin noted that there was no difference between arms regarding toxicity and quality of life. Grade 3 or higher late genitourinary toxicities occurred in 20.6% of the high-dose arm, versus 19.9% in the control arm, while 1.6% of patients in each arm experienced a grade 3 or higher late digestive toxicity.

Hennequin noted that a variety of randomized trials have been conducted to evaluate the role of de-escalation in prostate cancer.

“Most of them demonstrated an improvement in biochemical control, but no demonstrated benefit in overall survival. However, most of these trials included a low number of high-risk patients, and most of (the patients) did not choose long-term ADT. They used no ADT or short-term ADT,” he added, also acknowledging that long-term ADT is the standard of care in this patient population.

“The question remains: Is it necessary to increase the dose of radiotherapy in case of long-term ADT, or is the standard dose good enough for these patients?” Hennequin said.

Therefore, in the randomized phase 3 trial, high-risk patients were randomized to receive either dose-escalated (80 Gy) or conventional-dose (70 Gy) radiotherapy plus three years of ADT to determine the efficacy and safety of dose escalation in combination with long-term ADT.

Investigators stratified patients by lymph node resection and institution.

PFS served as the trial’s primary endpoint, while secondary endpoints included cancer-specific survival, OS and late toxicity. In the updated evaluation of the trial, six-year biochemical or clinical PFS was the primary endpoint; OS, specific survival, acute and delayed toxicities, and quality of life were the secondary endpoints; and exploratory endpoints included clinical relapse-free survival and metastasis-free survival.

In total, 505 patients from across 25 French centers were recruited from June 4, 2009, to Jan. 24, 2013. Patients were a median age of 71 years (range, 52-80), with the majority reporting just one high-risk disease factor (64.6%). Further, 16.4% of patients received lymph node dissection.

The median duration for ADT was 33.4 months, while 82.9% of patients underwent pelvic lymph node radiation, and 6 patients did not have radiotherapy performed. Interestingly, according to Hennequin, 80.6% of the dose-escalation arm received intensity-modulated radiation therapy (IMRT) in addition to ADT.

“Obviously IMRT is required to obtain these results. So, we have now level 1 evidence that high-dose (radiotherapy) with long-term ADT must be the standard of care in high-risk prostate cancer patients,” Hennequin concluded.


For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.

Related Videos
Woman with dark brown hair and pink lipstick wearing a light pink blouse with a light brown blazer. Patients should have conversations with their providers about treatments after receiving diagnoses.
Man in a navy suit with a purple tie. Dr. Saby George talks to CURE about how treatment with Opdivo could mitigate disparities in patients with kidney cancer.
Dr. Andrea Apolo in an interview with CURE
Dr. Kim in an interview with CURE
Dr. Barzi in an interview with CURE
Related Content