Long Term Results of Immediate Adjuvant Hormonal Therapy with Goserelin in Patients with Locally Advanced Prostate Cancer Treated with Radiotherapy (Phase III EORTC Study)

Todd Doyle, MD
OncoLink Assistant Editor
Last Modified: November 1, 1999

Presenter: Bolla M et al
Affiliation: EORTC Radiotherapy Cooperative Group

Summary:
Traditionally, patients with locally advanced, high risk adenocarcinoma of the prostate have been treated with radiation therapy. However, local control and survival have been somewhat disappointing. This study was initiated to investigate whether concurrent hormonal therapy in addition to radiation therapy could improve outcomes. This is the most recent update of this data since its publication in the New England Journal of Medicine two years ago.

Methods:
Four hundred fifteen patients with T1/T2 adenocarcinoma of the prostate (grade 3), or T3/T4 (any grade) were stratified for prognostic factors and randomized to receive radiation therapy alone or LHRH agonist plus radiation therapy. Hormones were started on day one of RT and continued for three years. The majority of patients were pathologically staged as N0. The median followup is now 65 months.

Results:

Outcomes for the RT/hormone group were statistically significantly better.
Five year local control was 79% for the RT group versus 97% for the combined group.
Clincal disease free survival was improved from 40% to 75%.
Five year overall survival favored the combined group (78% versus 62%).
There was no difference in acute toxicity or late toxicity with the exception of hot flashes which occured in 33% of the hormone/RT group and 1% of the RT alone group.

Clinical/Scientific Implications:

Based on the long term results of this study, patients with locally advanced, high risk adenocarcinoma of the prostate should be strongly considered for combined treatment with hormones in addition to radiation therapy.
Promising results for this same population of patients have recently been reported with conformal, dose escalation radiation therapy alone.
Future investigations comparing these two treatment approaches may be beneficial.

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