Long-term versus short-term androgen deprivation combined with EBRT for unfavourable prostate cancer
Mené en Espagne entre 2005 et 2010 sur 355 patients atteints d'un adénocarcinome de la prostate de stade localisé, à risque intermédiaire ou élevé de récidive et traité par radiothérapie à forte dose de rayonnements (durée médiane de suivi : 119,4 mois), cet essai randomisé multicentrique de phase III évalue la durée optimale, du point de vue de la survie globale, de la survie sans métastase, de la survie sans maladie biochimique et de la survie par cause, de la thérapie anti-androgénique
Previous mature trials on long-term versus short-term androgen deprivation combined with external beam radiotherapy (EBRT) for prostate cancer were limited to conventional dose radiotherapy (65–70 Gy) leaving some uncertainty as to whether the same conclusions would apply with modern EBRT doses and techniques.1–3 In 2017,1 the 20-year follow-up of RTOG 9202 compared androgen deprivation for 4 months versus 28 months combined with conventional doses of EBRT of 65–70 Gy in 1554 men. Long-term androgen deprivation (LTAD) improved 15-year distant metastasis-free survival from 74·0% (95% CI 70·8–77·1) to 82·6% (79·8–85·3; p<0·0001), biochemical failure-free survival from 38·8% (95% CI 35·4–42·4) to 54·6% (51·0–58·2; p<0·0001), and disease-free survival from 10·0% (95% CI 6·8–12·4) to 15·7% (10·1–18·5). There was also a significant increase in 15-year overall survival (29·8% [95% CI 26·4–33·2] vs 27·1% [23·8–30·0]; p=0·03), which was more evident for patients with tumours with Gleason scores of 8–10 than patients with locally advanced tumours with lower Gleason scores.
The Lancet Oncology , commentaire, 2021