UCLA Journal of Radiation Oncology Fall and Winter 2022 - Flipbook - Page 35
UCLA RADIATION ONCOLOGY JOURNAL
outcomes with a strong correlation to RT field size.
They believe that concurrent and adjuvant ADT
should be the standard of care where short-term
ADT is indicated in combination with prostate-only
RT.
the results should be “considered practice-changing
with regards to how ADT is sequenced with radiation
for patients getting short courses of ADT with
prostate radiation.”
He says future trials currently in the pipeline may
yield more answers about the benefit of neoadjuvant/
concurrent ADT sequencing with whole-pelvis RT in
patients with intermediate- and high-risk prostate
cancer.
METHODS
The researchers conducted a new analysis of
individual patient data from 12 randomized
trials in which patients received short-term ADT
either before and during their radiation therapy
or during and after for localized prostate cancer.
Data was obtained through the Meta-Analysis
of Randomized Trials in Cancer of the Prostate
(MARCAP) Consortium, a first-of-its-kind repository
for worldwide clinical trials involving patients with
prostate cancer. The consortium was co-founded
in 2020 by Drs. Amar Kishan of the UCLA Jonsson
Comprehensive Cancer Center and Daniel Spratt
with University Hospitals Seidman Cancer Center in
Cleveland.
AUTHORS
First author Ting Martin Ma is with the UCLA
Department of Radiation Oncology, as is
corresponding author Kishan, who also represents
the MARCAP consortium. Yilun Sun, an equal
contributor to the study, is with Case Western
Reserve University School of Medicine. MARCAP cofounder Spratt also was an equal study contributor.
Other authors are listed in the publication.
FUNDING / POTENTIAL CONFLICTS OF INTEREST
Their analysis included performing inverse
probability of treatment weighting (IPTW) with
propensity scores derived from factors such as
age, initial PSA score, Gleason score, T stage, RT
dose and mid-trial enrollment year. Metastasisfree survival and overall survival were assessed
by Cox regression models adjusted for IPTW and
analyzed independently for men receiving prostateonly RT versus whole-pelvis RT. Adjusted Fine and
Gray competing risk models were built to evaluate
distant metastasis (DM) and prostate cancer-specific
mortality.
Kishan reports funding support from grant
P50CA09213 from the Prostate Cancer National
Institutes of Health Specialized Programs of
Research Excellence and grant W81XWH-22-1-0044
from the Department of Defense, as well as grant
RSD1836 from the Radiological Society of North
America. Additional funding came from the STOP
Cancer organization, UCLA Jonsson Comprehensive
Cancer Center, Prostate Cancer Foundation and
American Society of Radiation Oncology, as well as
donations from the DeSilva, McCarrick and Bershad
families. ☐
EXPERT COMMENTS
No other authors had conflicts to declare.
“To our knowledge, this study represents the first
time a significant association has been demonstrated DOI: 10.1200/JCO.22.00970
between concurrent and adjuvant ADT sequencing
and overall survival rates among prostate cancer
patients,” said Kishan, corresponding author for
the study. “For patients receiving prostate-only RT,
concurrent/adjuvant sequencing is associated with
optimal outcomes.”
Kishan, who is vice-chair of Clinical and
Translational Research and chief of genitourinary
oncology for Radiation Oncology at UCLA, noted that
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