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ADT Plus EBRT Improves OS in Prostate Cancer Over BT Plus EBRT

Study findings suggest that omitting androgen-deprivation therapy (ADT) in favor of external beam radiotherapy (EBRT) plus brachytherapy boost (BT) may lessen overall survival (OS) compared with EBRT plus ADT in patients with intermediate- and high-risk prostate cancer (J Clin Oncol. 2020 May 12. Epub ahead of print).

“Practice patterns indicate that those who receive BT are significantly less likely to receive ADT, and thus we sought to perform a network meta-analysis to compare the predicted outcomes of a randomized trial of EBRT plus ADT versus EBRT plus BT,” said William C. Jackson, MD, Department of Radiation Oncology, University of Michigan, Ann Arbor, and co-investigators.

Using 6 published clinical trials comparing EBRT with or without ADT (n = 4663) and 3 comparing EBRT with or without BT (n = 718), Dr Jackson et al conducted a systematic review. For each comparison, they carried out standard fixed-effects meta-analyses, and a meta-regression was used to adjust for use and duration of ADT.

Furthermore, EBRT plus ADT versus EBRT plus BT were compared via network meta-analyses.

Ultimately, ADT plus EBRT was shown to improve OS (hazard ratio [HR], 0.71; 95% CI, 0.62-0.81), whereas adding BT to EBRT did not significantly improve OS (HR, 1.03; 95% CI, 0.78-1.36).

According to a network meta-analysis, EBRT plus ADT led to improved OS compared with EBRT plus BT (HR, 0.68; 95% CI, 0.52-0.89).

“Our findings suggest that current practice patterns of omitting ADT with EBRT plus BT may result in inferior OS compared with EBRT plus ADT in men with intermediate- and high-risk prostate cancer,” Dr Jackson and colleagues said.

“ADT for these men should remain a critical component of treatment regardless of radiotherapy delivery method until randomized evidence demonstrates otherwise,” they concluded.—Hina Porcelli

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