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ASCO GU 2024: Dose-Escalation vs Conventional Radiotherapy in High-Risk Prostate Cancer

By: Celeste L. Dixon
Posted: Tuesday, February 6, 2024

Long-term results of the GETUG-AFU 18 study indicate that in patients with high-risk prostate cancer, dose-escalation radiotherapy of 80 Gy—vs conventional radiotherapy of 70 Gy—in combination with long-term (3-year) androgen-deprivation therapy (ADT) is effective and safe. Specifically, it increases the biochemical or chemical progression-free survival rate (P = .0005), specific survival (P = .0090), and overall survival (P = .0039) without increasing long-term toxicity. Christophe Hennequin, MD, PhD, of Saint-Louis Hospital, Paris, and colleagues reported on this phase III trial of more than 500 patients at the 2024 American Society of Clinical Oncology (ASCO) Genitourinary (GU) Cancers Symposium (Abstract LBA259).

The primary endpoint of GETUG-AFU 18, the rates of biochemical or clinical progression-free survival at 5 years were 91.4% and 88.1% in the dose-escalated and conventional radiotherapy arms, respectively. The corresponding 7-year results were 88.1% and 79.2%, respectively.

No significant differences in late toxicity between the arms were reported, with 78.2% and 76.1% grade ≥ 2 toxicity with dose-escalated radiotherapy and conventional radiotherapy, respectively. Previously, said the investigators, conventional radiotherapy given at a dose of 80 Gy was generally well tolerated, but occurrence of grade 3 or 4 toxicities was significantly more frequent than at a dose of 70 Gy. Also, ADT had been reported to increase radiotherapy-related toxicity.

In GETUG-AFU 18, which recruited between 2009 and 2013, the median prostate-specific antigen (PSA) value was 13.8 ng/mL. Additionally, 268 patients (53.1%) had a Gleason score ≥ 8, 62.3% had cT3, and 16.4% had pelvic lymph node dissection. To be eligible, patients with prostate adenocarcinoma needed negative lymph node status and disease defined as high risk (cT3–T4 or PSA ≥ 20 ng/mL or Gleason score ≥ 8–10). Pelvic nodal irradiation (46 Gy) was performed for all patients except those with negative pelvic lymph node dissection.

Disclosure: For full disclosures of the study authors, visit

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