ESMO 2019: RADICALS-RT Trial Makes ‘Strong Case’ for Observation After Radical Prostatectomy
Posted: Monday, September 30, 2019
Based on the final results of the RADICALS-RT trial, men with prostate cancer may avoid radiotherapy after radical prostatectomy. The study found no difference in disease recurrence at 5 years between men who routinely had radiotherapy shortly after surgery and men who had radiotherapy only with recurrence. These findings were presented at the European Society for Medical Oncology (ESMO) Congress 2019 in Barcelona (Abstract LBA49_PR) by Chris Parker, MD, of the Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, and colleagues. These results were confirmed in a collaborative meta-analysis combining data on 2,151 men from RADICALS-RT, RAVES, and GETUG-AFU17, which also was presented at ESMO by Claire Vale, PhD, of MRC Clinical Trials Unit, University College London (Abstract LBA48_PR).
“There is a strong case now that observation should be the standard approach after surgery [in men with prostate cancer], and radiotherapy should only be used if the cancer comes back,” stated Dr. Parker in an ESMO press release. “The good news is that in the future, many men will avoid the side effects of radiotherapy.”
In the RADICALS-RT trial, at a median follow-up of 5 years, progression-free survival was 85% in men who received postoperative radiotherapy and 88% in those who received observation alone, with radiotherapy kept as an option if disease recurred. In the meta-analysis, there was no evidence that adjuvant radiotherapy improved event-free survival compared with early salvage radiotherapy (hazard ratio = 1.09).
Some experts believe that longer follow-up is necessary for the primary endpoint of RADICALS-RT: freedom from distant metastases at 10 years. Future research will focus on pinpointing which patients may require adjuvant radiotherapy to avoid an early local relapse and potential subsequent metastases.
Disclosure: For full disclosures of the study authors, visit esmo.org.