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The first 2 authors contributed equally to this article.
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Original Article
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Does hormone treatment added to radiotherapy improve outcome in locally advanced prostate cancer?†
Meta-Analysis of Randomized Trials
Article first published online: 29 MAY 2009
DOI: 10.1002/cncr.24392
Copyright © 2009 American Cancer Society
Additional Information
How to Cite
Bria, E., Cuppone, F., Giannarelli, D., Milella, M., Ruggeri, E. M., Sperduti, I., Pinnarò, P., Terzoli, E., Cognetti, F. and Carlini, P. (2009), Does hormone treatment added to radiotherapy improve outcome in locally advanced prostate cancer?. Cancer, 115: 3446–3456. doi: 10.1002/cncr.24392
- †
Presented and awarded at the Presidential Symposium of the 31st European Society for Medical Oncology Congress, Istanbul, Turkey, September 29-October 3, 2006. Preliminary data presented at the 42nd American Society of Medical Oncology annual meeting, Atlanta, Georgia, June 2-6, 2006.
Publication History
- Issue published online: 20 JUL 2009
- Article first published online: 29 MAY 2009
- Manuscript Accepted: 6 JAN 2009
- Manuscript Revised: 5 JAN 2009
- Manuscript Received: 11 DEC 2008
Funded by
- National Ministry of Health and the Italian Association for Cancer Research
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Keywords:
- prostate cancer;
- meta-analysis;
- hormone;
- radiotherapy
To quantify the magnitude of the benefit of adding hormone treatment to exclusive radiotherapy for locally advanced prostate cancer, a literature-based meta-analysis was conducted. The addition of hormone suppression can significantly decrease the recurrences and improve the survival of patients affected by localized prostate cancer over radiotherapy, without affecting toxicity.
Abstract
BACKGROUND:
To quantify the magnitude of benefit of the addition of hormone treatment (HT) to exclusive radiotherapy for locally advanced prostate cancer, a literature-based meta-analysis was conducted.
METHODS:
Event-based relative risks (RR) with 95% confidence intervals (CIs) were derived through a random-effect model. Differences in primary (biochemical failure and clinical progression-free survival) and secondary outcomes (cancer-specific survival, overall survival [OS], recurrence patterns, and toxicity) were explored. Absolute differences and numbers of patients needed to treat (NNT) were calculated. A heterogeneity test, a metaregression analysis with clinical predictors of outcome, and a correlation analysis for surrogate endpoints were also performed.
RESULTS:
Seven trials (4387 patients) were gathered. Hormone suppression significantly decreased both biochemical failure (RR, 0.76; 95% CI, 0.70-0.82; P < .0001) and clinical progression-free survival (RR, 0.81; 95% CI 0.71-0.93; P = .002), with absolute differences of 10% and 7.7%, respectively, which translates into 10 and 13 NNT. cancer-specific survival (RR, 0.76; 95% CI, 0.69-0.83; P < .0001) and OS (RR, 0.86; 95% CI, 0.80-0.93; P < .0001) were also significantly improved by the addition of HT, without significant heterogeneity, with absolute differences of 5.5% and 4.9%, respectively, which translates into 18 and 20 NNT. Local and distant relapse were significantly decreased by HT, by 36% and 28%, respectively, and no significant differences in toxicity were found. Primary and secondary efficacy outcomes were significantly correlated.
CONCLUSIONS:
Hormone suppression plus radiotherapy significantly decreases recurrence and mortality of patients with localized prostate cancer, without affecting toxicity. Cancer 2009. © 2009 American Cancer Society.