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Radiation Therapy After Prostate Surgery Offers No Benefit

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Radiation
therapy (RT) following radical prostatectomy (RP) for high-risk localized prostate
cancer offers no advantage in terms of biochemical recurrence compared with delaying
radiation therapy until development of biochemical recurrence, study findings presented
at the European Society for Medical Oncology (ESMO) annual congress in
Barcelona, Spain, show.

Consequently,
many men will be able to avoid the adverse effects of radiotherapy, which
include urinary incontinence and urethral stricture, according to investigators.

The
study, RADICALS-RT, is the largest trial to date looking at postoperative radiotherapy
for prostate cancer. It enrolled 1396 patients following RP from the United
Kingdom, Denmark, Canada, and Ireland. Investigators randomly assigned patients
to receiving postoperative RT or the standard approach with observation, with RT
an option if patients experienced biochemical recurrence.

At
a median follow-up of 5 years, biochemical progression-free survival rates were
85% in the RT group and 88% in the observation arm, a difference that was not
statistically significant, the investigators reported.

“The
results suggest that radiotherapy is equally effective whether it is given to
all men shortly after surgery or given later to those men with recurrent
disease,” first author Christopher C. Parker, MD, of The Royal Marsden NHS
Foundation Trust and Institute of Cancer Research in London, said in an ESMO
press release. “There is a strong case now that observation should be the
standard approach after surgery and radiotherapy should only be used if the
cancer comes back.”

Commenting
on the study, Xavier Maldonado, MD, of Hospital Universitari Vall d’Hebron in
Barcelona, observed: “These are the first results to suggest that postoperative
radiotherapy for prostate cancer could be omitted or delayed in some patients.
This will shorten the duration of treatment for these patients and allow better
use of resources since today’s radiotherapy is technically sophisticated and
therefore expensive. However, strict follow-up will be needed to identify
patients requiring salvage radiotherapy.”

In
a separate presentation, investigators presented the results of the ARTISTIC meta-analysis
of 3 randomized trials—including the RADICALS-RT trial—that confirm the
findings of Dr Parker and his team. The meta-analysis looked at data from 2151
men across the 3 trials. Of these, 1074 and 1077 patients were randomly
assigned to receive adjuvant RT and early salvage RT, respectively. The
meta-analysis found no statistically significant difference between the adjuvant
RT and salvage RT arms with respect to PSA-driven event-free survival.

“Results
of the ARTISTIC meta-analysis confirm those of RADICALs, and provide greater
evidence to support the routine use of observation and early salvage therapy,”
first author Claire Vale, PhD, of University College London, stated in the ESMO
release.

References

Parker
C, Clarke NW, Cook A, et al. Timing of radiotherapy (RT) after radical
prostatectomy (RP): First results from the RADICALS-RT randomized controlled
trial (RCT) [NCG00541047]. Data presented at the European Society for Medical
Oncology annual congress in Barcelona, September 27 to October 1. Abstract
LBA49_PR.

https://www.esmo.org/Press-Office/Press-Releases/ESMO-Congress-prostate-cancer-surgery-radicals-artistic-Parker-Vale

Vale
CL, Brihoum M, Chabaud S, et al. Adjuvant or salvage radiotherapy for the
treatment of localised prostate cancer? A prospectively planned aggregate data
meta-analysis. Data presented at the European Society for Medical Oncology
annual congress in Barcelona, September 27 to October 1. Abstract LBA48_PR.

https://www.esmo.org/Press-Office/Press-Releases/ESMO-Congress-prostate-cancer-surgery-radicals-artistic-Parker-Vale

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