Whole-Pelvic Radiation Therapy for Unfavorable-Risk Prostate Cancer

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As reported in the Journal of Clinical Oncology by Sayan et al, analysis of long-term findings from the phase III Dana-Farber Cancer Institute Trial 05-043 showed that whole-pelvic radiation therapy (WPRT) was associated with favorable survival outcomes vs prostate-only radiation therapy (PORT) among patients aged < 65 years with unfavorable-risk prostate cancer.

Study Details

In the trial, 350 patients from sites in the United States, Australia, and New Zealand were randomly assigned between 2005 and 2015 to receive androgen-deprivation therapy (ADT) and radiation therapy plus docetaxel (n = 175) or ADT and radiation therapy (n = 175). Radiation therapy consisted of WPRT in 45 patients in the ADT-radiation therapy-docetaxel group and in 43 in the ADT-radiation therapy group, and PORT in 130 and 132 patients, respectively. The primary objective of the analysis was to determine the relationship between type of radiation therapy and all-cause mortality and prostate cancer–specific mortality after adjustment for known prostate cancer prognostic factors and comorbidity.

Key Findings

After a median follow-up of 10.2 years (interquartile range = 8.0–11.4 years), 89 patients (25.4%) had died; of these, 42 (47.2%) died from prostate cancer.

Among patients aged < 65 years, WPRT was associated with a significantly reduced risk vs PORT for all-cause mortality (adjusted hazard ratio [HR] = 0.33, 95% confidence interval [CI] = 0.11–0.97, P = .04); no significant reduction was observed among patients aged ≥ 65 years (adjusted HR = 0.90, 95% CI = 0.48–1.68, P = .73). Among patients aged < 65 years, WPRT was associated with a numerical benefit in prostate cancer–specific mortality (adjusted HR = 0.17, 95% CI = 0.02–1.35, P = .09), whereas no reduction was observed among those aged ≥ 65 years (adjusted HR = 1.40, 95% CI = 0.56–3.50, P = .47).

Adjusted 10-year estimates of all-cause mortality in patients aged < 65 years were 8.42% among those receiving WPRT vs 30.10% among those receiving PORT (P = .04). Among patents aged ≥ 65 years, the respective estimates were 28.51% vs 28.70% (P = .73).

The investigators concluded, “WPRT has the potential to reduce mortality in younger men with unfavorable-risk prostate cancer.”

Mutlay Sayan, MD, of the Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: For full disclosures of the study authors, visit

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