Short Androgen Suppression and Radiation Dose Escalation in Prostate Cancer: 12-Year Results of EORTC Trial 22991 in Patients With Localized Intermediate-Risk Disease

Michel Bolla; Anouk Neven; Philippe Maingon; Christian Carrie; Ana Boladeras; Demetrios Andreopoulos; Antoine Engelen; Santhanam Sundar; Elzbieta M. van der Steen-Banasik; John Armstrong; Karine Peignaux-Casasnovas; Jihane Boustani; Fernanda G. Herrera; Bradley R. Pieters; Annerie Slot; Amit Bahl; Christopher D. Scrase; David Azria; Jan Jansa; Joe M. O'Sullivan; Alphonsus C. M. Van Den Bergh; Laurence Collette

doi:10.1200/jco.21.00855

Short Androgen Suppression and Radiation Dose Escalation in Prostate Cancer: 12-Year Results of EORTC Trial 22991 in Patients With Localized Intermediate-Risk Disease

Michel Bolla, Anouk Neven, Philippe Maingon, Christian Carrie, Ana Boladeras, Demetrios Andreopoulos, Antoine Engelen, Santhanam Sundar, Elzbieta M. van der Steen-Banasik, John Armstrong, Karine Peignaux-Casasnovas, Jihane Boustani, Fernanda G. Herrera, Bradley R. Pieters, Annerie Slot, Amit Bahl, Christopher D. Scrase, David Azria, Jan Jansa, Joe M. O'SullivanAlphonsus C. M. Van Den Bergh, Laurence Collette

Patrick G Johnston Centre for Cancer Research

Research output: Contribution to journal › Article › peer-review

30 Citations (Scopus)

Abstract

PURPOSE: The European Organisation for Research and Treatment of Cancer (EORTC) trial 22991 ( NCT00021450 ) showed that 6 months of concomitant and adjuvant androgen suppression (AS) improves event- (EFS, Phoenix) and clinical disease-free survival (DFS) of intermediate- and high-risk localized prostatic carcinoma, treated by external-beam radiotherapy (EBRT) at 70-78 Gy. We report the long-term results in intermediate-risk patients treated with 74 or 78 Gy EBRT, as per current guidelines.
PATIENT AND METHODS: Of 819 patients randomly assigned between EBRT or EBRT plus AS started on day 1 of EBRT, 481 entered with intermediate risk (International Union Against Cancer TNM 1997 cT1b-c or T2a with prostate-specific antigen (PSA) ≥ 10 ng/mL or Gleason ≤ 7 and PSA ≤ 20 ng/mL, N0M0) and had EBRT planned at 74 (342 patients, 71.1%) or 78 Gy (139 patients, 28.9%). We report the trial primary end point EFS, DFS, distant metastasis–free survival (DMFS), and overall survival (OS) by intention-to-treat stratified by EBRT dose at two-sided α = 5%.
RESULTS: At a median follow-up of 12.2 years, 92 of 245 patients and 132 of 236 had EFS events in the EBRT plus AS and EBRT arm, respectively, mostly PSA relapse (48.7%) or death (45.1%). EBRT plus AS improved EFS and DFS (hazard ratio [HR] = 0.53; CI, 0.41 to 0.70; P < .001 and HR = 0.67; CI, 0.49 to 0.90; P = .008). At 10 years, DMFS was 79.3% (CI, 73.4 to 84.0) with EBRT plus AS and 72.7% (CI, 66.2 to 78.2) with EBRT (HR = 0.74; CI, 0.53 to 1.02; P = .065). With 140 deaths (EBRT plus AS: 64; EBRT: 76), 10-year OS was 80.0% (CI, 74.1 to 84.7) with EBRT plus AS and 74.3% (CI, 67.8 to 79.7) with EBRT, but not statistically significantly different (HR = 0.74; CI, 0.53 to 1.04; P = .082).
CONCLUSION: Six months of concomitant and adjuvant AS statistically significantly improves EFS and DFS in intermediate-risk prostatic carcinoma, treated by irradiation at 74 or 78 Gy. The effects on OS and DMFS did not reach statistical significance.

Original language	English
Pages (from-to)	3022-3033.
Number of pages	12
Journal	Journal of Clinical Oncology
Volume	39
Issue number	27
Early online date	26 Jul 2021
DOIs	https://doi.org/10.1200/jco.21.00855
Publication status	Published - 20 Sept 2021

Keywords

Cancer Research
Oncology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Bolla, M., Neven, A., Maingon, P., Carrie, C., Boladeras, A., Andreopoulos, D., Engelen, A., Sundar, S., van der Steen-Banasik, E. M., Armstrong, J., Peignaux-Casasnovas, K., Boustani, J., Herrera, F. G., Pieters, B. R., Slot, A., Bahl, A., Scrase, C. D., Azria, D., Jansa, J., ... Collette, L. (2021). Short Androgen Suppression and Radiation Dose Escalation in Prostate Cancer: 12-Year Results of EORTC Trial 22991 in Patients With Localized Intermediate-Risk Disease. Journal of Clinical Oncology, 39(27), 3022-3033. https://doi.org/10.1200/jco.21.00855

@article{b9af7fd0f316468f95eede4dc3dddb19,

title = "Short Androgen Suppression and Radiation Dose Escalation in Prostate Cancer: 12-Year Results of EORTC Trial 22991 in Patients With Localized Intermediate-Risk Disease",

abstract = "PURPOSE: The European Organisation for Research and Treatment of Cancer (EORTC) trial 22991 ( NCT00021450 ) showed that 6 months of concomitant and adjuvant androgen suppression (AS) improves event- (EFS, Phoenix) and clinical disease-free survival (DFS) of intermediate- and high-risk localized prostatic carcinoma, treated by external-beam radiotherapy (EBRT) at 70-78 Gy. We report the long-term results in intermediate-risk patients treated with 74 or 78 Gy EBRT, as per current guidelines. PATIENT AND METHODS: Of 819 patients randomly assigned between EBRT or EBRT plus AS started on day 1 of EBRT, 481 entered with intermediate risk (International Union Against Cancer TNM 1997 cT1b-c or T2a with prostate-specific antigen (PSA) ≥ 10 ng/mL or Gleason ≤ 7 and PSA ≤ 20 ng/mL, N0M0) and had EBRT planned at 74 (342 patients, 71.1%) or 78 Gy (139 patients, 28.9%). We report the trial primary end point EFS, DFS, distant metastasis–free survival (DMFS), and overall survival (OS) by intention-to-treat stratified by EBRT dose at two-sided α = 5%. RESULTS: At a median follow-up of 12.2 years, 92 of 245 patients and 132 of 236 had EFS events in the EBRT plus AS and EBRT arm, respectively, mostly PSA relapse (48.7%) or death (45.1%). EBRT plus AS improved EFS and DFS (hazard ratio [HR] = 0.53; CI, 0.41 to 0.70; P < .001 and HR = 0.67; CI, 0.49 to 0.90; P = .008). At 10 years, DMFS was 79.3% (CI, 73.4 to 84.0) with EBRT plus AS and 72.7% (CI, 66.2 to 78.2) with EBRT (HR = 0.74; CI, 0.53 to 1.02; P = .065). With 140 deaths (EBRT plus AS: 64; EBRT: 76), 10-year OS was 80.0% (CI, 74.1 to 84.7) with EBRT plus AS and 74.3% (CI, 67.8 to 79.7) with EBRT, but not statistically significantly different (HR = 0.74; CI, 0.53 to 1.04; P = .082). CONCLUSION: Six months of concomitant and adjuvant AS statistically significantly improves EFS and DFS in intermediate-risk prostatic carcinoma, treated by irradiation at 74 or 78 Gy. The effects on OS and DMFS did not reach statistical significance.",

keywords = "Cancer Research, Oncology",

author = "Michel Bolla and Anouk Neven and Philippe Maingon and Christian Carrie and Ana Boladeras and Demetrios Andreopoulos and Antoine Engelen and Santhanam Sundar and {van der Steen-Banasik}, {Elzbieta M.} and John Armstrong and Karine Peignaux-Casasnovas and Jihane Boustani and Herrera, {Fernanda G.} and Pieters, {Bradley R.} and Annerie Slot and Amit Bahl and Scrase, {Christopher D.} and David Azria and Jan Jansa and O'Sullivan, {Joe M.} and {Van Den Bergh}, {Alphonsus C. M.} and Laurence Collette",

year = "2021",

month = sep,

day = "20",

doi = "10.1200/jco.21.00855",

language = "English",

volume = "39",

pages = "3022--3033.",

journal = "Journal of Clinical Oncology",

issn = "0732-183X",

publisher = "Lippincott Williams and Wilkins",

number = "27",

}

Bolla, M, Neven, A, Maingon, P, Carrie, C, Boladeras, A, Andreopoulos, D, Engelen, A, Sundar, S, van der Steen-Banasik, EM, Armstrong, J, Peignaux-Casasnovas, K, Boustani, J, Herrera, FG, Pieters, BR, Slot, A, Bahl, A, Scrase, CD, Azria, D, Jansa, J, O'Sullivan, JM, Van Den Bergh, ACM & Collette, L 2021, 'Short Androgen Suppression and Radiation Dose Escalation in Prostate Cancer: 12-Year Results of EORTC Trial 22991 in Patients With Localized Intermediate-Risk Disease', Journal of Clinical Oncology, vol. 39, no. 27, pp. 3022-3033. https://doi.org/10.1200/jco.21.00855

TY - JOUR

T1 - Short Androgen Suppression and Radiation Dose Escalation in Prostate Cancer: 12-Year Results of EORTC Trial 22991 in Patients With Localized Intermediate-Risk Disease

AU - Bolla, Michel

AU - Neven, Anouk

AU - Maingon, Philippe

AU - Carrie, Christian

AU - Boladeras, Ana

AU - Andreopoulos, Demetrios

AU - Engelen, Antoine

AU - Sundar, Santhanam

AU - van der Steen-Banasik, Elzbieta M.

AU - Armstrong, John

AU - Peignaux-Casasnovas, Karine

AU - Boustani, Jihane

AU - Herrera, Fernanda G.

AU - Pieters, Bradley R.

AU - Slot, Annerie

AU - Bahl, Amit

AU - Scrase, Christopher D.

AU - Azria, David

AU - Jansa, Jan

AU - O'Sullivan, Joe M.

AU - Van Den Bergh, Alphonsus C. M.

AU - Collette, Laurence

PY - 2021/9/20

Y1 - 2021/9/20

N2 - PURPOSE: The European Organisation for Research and Treatment of Cancer (EORTC) trial 22991 ( NCT00021450 ) showed that 6 months of concomitant and adjuvant androgen suppression (AS) improves event- (EFS, Phoenix) and clinical disease-free survival (DFS) of intermediate- and high-risk localized prostatic carcinoma, treated by external-beam radiotherapy (EBRT) at 70-78 Gy. We report the long-term results in intermediate-risk patients treated with 74 or 78 Gy EBRT, as per current guidelines. PATIENT AND METHODS: Of 819 patients randomly assigned between EBRT or EBRT plus AS started on day 1 of EBRT, 481 entered with intermediate risk (International Union Against Cancer TNM 1997 cT1b-c or T2a with prostate-specific antigen (PSA) ≥ 10 ng/mL or Gleason ≤ 7 and PSA ≤ 20 ng/mL, N0M0) and had EBRT planned at 74 (342 patients, 71.1%) or 78 Gy (139 patients, 28.9%). We report the trial primary end point EFS, DFS, distant metastasis–free survival (DMFS), and overall survival (OS) by intention-to-treat stratified by EBRT dose at two-sided α = 5%. RESULTS: At a median follow-up of 12.2 years, 92 of 245 patients and 132 of 236 had EFS events in the EBRT plus AS and EBRT arm, respectively, mostly PSA relapse (48.7%) or death (45.1%). EBRT plus AS improved EFS and DFS (hazard ratio [HR] = 0.53; CI, 0.41 to 0.70; P < .001 and HR = 0.67; CI, 0.49 to 0.90; P = .008). At 10 years, DMFS was 79.3% (CI, 73.4 to 84.0) with EBRT plus AS and 72.7% (CI, 66.2 to 78.2) with EBRT (HR = 0.74; CI, 0.53 to 1.02; P = .065). With 140 deaths (EBRT plus AS: 64; EBRT: 76), 10-year OS was 80.0% (CI, 74.1 to 84.7) with EBRT plus AS and 74.3% (CI, 67.8 to 79.7) with EBRT, but not statistically significantly different (HR = 0.74; CI, 0.53 to 1.04; P = .082). CONCLUSION: Six months of concomitant and adjuvant AS statistically significantly improves EFS and DFS in intermediate-risk prostatic carcinoma, treated by irradiation at 74 or 78 Gy. The effects on OS and DMFS did not reach statistical significance.

AB - PURPOSE: The European Organisation for Research and Treatment of Cancer (EORTC) trial 22991 ( NCT00021450 ) showed that 6 months of concomitant and adjuvant androgen suppression (AS) improves event- (EFS, Phoenix) and clinical disease-free survival (DFS) of intermediate- and high-risk localized prostatic carcinoma, treated by external-beam radiotherapy (EBRT) at 70-78 Gy. We report the long-term results in intermediate-risk patients treated with 74 or 78 Gy EBRT, as per current guidelines. PATIENT AND METHODS: Of 819 patients randomly assigned between EBRT or EBRT plus AS started on day 1 of EBRT, 481 entered with intermediate risk (International Union Against Cancer TNM 1997 cT1b-c or T2a with prostate-specific antigen (PSA) ≥ 10 ng/mL or Gleason ≤ 7 and PSA ≤ 20 ng/mL, N0M0) and had EBRT planned at 74 (342 patients, 71.1%) or 78 Gy (139 patients, 28.9%). We report the trial primary end point EFS, DFS, distant metastasis–free survival (DMFS), and overall survival (OS) by intention-to-treat stratified by EBRT dose at two-sided α = 5%. RESULTS: At a median follow-up of 12.2 years, 92 of 245 patients and 132 of 236 had EFS events in the EBRT plus AS and EBRT arm, respectively, mostly PSA relapse (48.7%) or death (45.1%). EBRT plus AS improved EFS and DFS (hazard ratio [HR] = 0.53; CI, 0.41 to 0.70; P < .001 and HR = 0.67; CI, 0.49 to 0.90; P = .008). At 10 years, DMFS was 79.3% (CI, 73.4 to 84.0) with EBRT plus AS and 72.7% (CI, 66.2 to 78.2) with EBRT (HR = 0.74; CI, 0.53 to 1.02; P = .065). With 140 deaths (EBRT plus AS: 64; EBRT: 76), 10-year OS was 80.0% (CI, 74.1 to 84.7) with EBRT plus AS and 74.3% (CI, 67.8 to 79.7) with EBRT, but not statistically significantly different (HR = 0.74; CI, 0.53 to 1.04; P = .082). CONCLUSION: Six months of concomitant and adjuvant AS statistically significantly improves EFS and DFS in intermediate-risk prostatic carcinoma, treated by irradiation at 74 or 78 Gy. The effects on OS and DMFS did not reach statistical significance.

KW - Cancer Research

KW - Oncology

U2 - 10.1200/jco.21.00855

DO - 10.1200/jco.21.00855

M3 - Article

SN - 0732-183X

VL - 39

SP - 3022-3033.

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

IS - 27

ER -

Short Androgen Suppression and Radiation Dose Escalation in Prostate Cancer: 12-Year Results of EORTC Trial 22991 in Patients With Localized Intermediate-Risk Disease

Abstract

Keywords

UN SDGs

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