Adjuvant Radiotherapy Versus Early Salvage Radiotherapy in Localized Prostate Cancer
Posted: Friday, October 16, 2020
For patients with prostate cancer who have undergone radical prostatectomy, adjuvant therapy plus short-term androgen-deprivation therapy (ADT) may not benefit in terms of event-free survival when compared with early salvage radiotherapy plus short-term hormone therapy, according to findings of the GETUG-AFU 17 trial presented in The Lancet Oncology. Pierre Richaud, MD, of the Institut Bergonié, Bordeaux, France, and colleagues noted that although their analysis lacked “statistical power,” adjuvant radiotherapy appeared to increase the risk of genitourinary toxicity and erectile dysfunction in patients.
“A policy of early salvage radiotherapy could spare men from overtreatment with radiotherapy and the associated adverse events,” the authors concluded.
In this phase III trial, performed at 46 French hospitals, the authors enrolled 424 patients with prostate cancer with an Eastern Cooperative Oncology Group performance score of 1 or less; they all had localized adenocarcinoma of the prostate and underwent radical prostatectomy. The patients were treated with immediate adjuvant radiotherapy or delayed salvage radiotherapy at the time of biochemical relapse. All study patients received 6 months of the hormone triptorelin.
The overall median follow-up was 75 months. The 5-year event-free survival rate was 90% for those treated with salvage radiotherapy, compared with 92% for those who received adjuvant radiotherapy. Acute grade 3 or worse toxic effects were seen in six patients treated with adjuvant radiotherapy and in four patients treated with salvage radiotherapy.
For those treated with adjuvant radiotherapy, 125 patients reported late grade 2 or worse genitourinary toxicities (59%), compared with 46 patients in the salvage-radiotherapy cohort (22%). Late genitourinary adverse events of grade 2 or worse occurred in 58 patients who received adjuvant radiotherapy (27%) and in 14 patients treated with salvage radiotherapy (7%). Late erectile dysfunction was grade 2 or worse in 60 patients treated with adjuvant radiotherapy (28%), compared with 17 patients treated with salvage radiotherapy (8%).
Disclosure: For full disclosure of the study authors, visit thelancet.com.