Impact of hormonal treatment duration in combination with radiotherapy for locally advanced prostate cancer: Meta-analysis of randomized trials

Federica Cuppone, Emilio Bria, Diana Giannarelli, Vanja Vaccaro, Michele Milella, Cecilia Nisticò, Enzo M. Ruggeri, Isabella Sperduti, Sergio Bracarda, Paola Pinnarò, Gaetano Lanzetta, Paola Muti, Francesco Cognetti, Paolo Carlini

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Hormone therapy plus radiotherapy significantly decreases recurrences and mortality of patients affected by locally advanced prostate cancer. In order to determine if difference exists according to the hormonal treatment duration, a literature-based meta-analysis was performed.Methods: Relative risks (RR) were derived through a random-effect model. Differences in primary (biochemical failure, BF; cancer-specific survival, CSS), and secondary outcomes (overall survival, OS; local or distant recurrence, LR/DM) were explored. Absolute differences (AD) and the number needed to treat (NNT) were calculated. Heterogeneity, a meta-regression for clinic-pathological predictors and a correlation test for surrogates were conducted.Results: Five trials (3,424 patients) were included. Patient population ranged from 267 to 1,521 patients. The longer hormonal treatment significantly improves BF (with significant heterogeneity) with an absolute benefit of 10.1%, and a non significant trend in CSS. With regard to secondary end-points, the longer hormonal treatment significantly decrease both the LR and the DM with an absolute difference of 11.7% and 11.5%. Any significant difference in OS was observed. None of the three identified clinico-pathological predictors (median PSA, range 9.5-20.35, Gleason score 7-10, 27-55% patients/trial, and T3-4, 13-77% patients/trial), did significantly affect outcomes. At the meta-regression analysis a significant correlation between the overall treatment benefit in BF, CSS, OS, LR and DM, and the length of the treatment was found (p≤0.03).Conclusions: Although with significant heterogeneity (reflecting different patient' risk stratifications), a longer hormonal treatment duration significantly decreases biochemical, local and distant recurrences, with a trend for longer cancer specific survival.

Original languageEnglish
Article number675
JournalBMC Cancer
Volume10
DOIs
Publication statusPublished - Dec 9 2010

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Meta-Analysis
Prostatic Neoplasms
Radiotherapy
Survival
Recurrence
Therapeutics
Neoplasms
Numbers Needed To Treat
Neoplasm Grading
Regression Analysis
Hormones
Mortality
Population

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Genetics

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Impact of hormonal treatment duration in combination with radiotherapy for locally advanced prostate cancer : Meta-analysis of randomized trials. / Cuppone, Federica; Bria, Emilio; Giannarelli, Diana; Vaccaro, Vanja; Milella, Michele; Nisticò, Cecilia; Ruggeri, Enzo M.; Sperduti, Isabella; Bracarda, Sergio; Pinnarò, Paola; Lanzetta, Gaetano; Muti, Paola; Cognetti, Francesco; Carlini, Paolo.

In: BMC Cancer, Vol. 10, 675, 09.12.2010.

Research output: Contribution to journalArticle

Cuppone, Federica ; Bria, Emilio ; Giannarelli, Diana ; Vaccaro, Vanja ; Milella, Michele ; Nisticò, Cecilia ; Ruggeri, Enzo M. ; Sperduti, Isabella ; Bracarda, Sergio ; Pinnarò, Paola ; Lanzetta, Gaetano ; Muti, Paola ; Cognetti, Francesco ; Carlini, Paolo. / Impact of hormonal treatment duration in combination with radiotherapy for locally advanced prostate cancer : Meta-analysis of randomized trials. In: BMC Cancer. 2010 ; Vol. 10.
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abstract = "Background: Hormone therapy plus radiotherapy significantly decreases recurrences and mortality of patients affected by locally advanced prostate cancer. In order to determine if difference exists according to the hormonal treatment duration, a literature-based meta-analysis was performed.Methods: Relative risks (RR) were derived through a random-effect model. Differences in primary (biochemical failure, BF; cancer-specific survival, CSS), and secondary outcomes (overall survival, OS; local or distant recurrence, LR/DM) were explored. Absolute differences (AD) and the number needed to treat (NNT) were calculated. Heterogeneity, a meta-regression for clinic-pathological predictors and a correlation test for surrogates were conducted.Results: Five trials (3,424 patients) were included. Patient population ranged from 267 to 1,521 patients. The longer hormonal treatment significantly improves BF (with significant heterogeneity) with an absolute benefit of 10.1{\%}, and a non significant trend in CSS. With regard to secondary end-points, the longer hormonal treatment significantly decrease both the LR and the DM with an absolute difference of 11.7{\%} and 11.5{\%}. Any significant difference in OS was observed. None of the three identified clinico-pathological predictors (median PSA, range 9.5-20.35, Gleason score 7-10, 27-55{\%} patients/trial, and T3-4, 13-77{\%} patients/trial), did significantly affect outcomes. At the meta-regression analysis a significant correlation between the overall treatment benefit in BF, CSS, OS, LR and DM, and the length of the treatment was found (p≤0.03).Conclusions: Although with significant heterogeneity (reflecting different patient' risk stratifications), a longer hormonal treatment duration significantly decreases biochemical, local and distant recurrences, with a trend for longer cancer specific survival.",
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T1 - Impact of hormonal treatment duration in combination with radiotherapy for locally advanced prostate cancer

T2 - Meta-analysis of randomized trials

AU - Cuppone, Federica

AU - Bria, Emilio

AU - Giannarelli, Diana

AU - Vaccaro, Vanja

AU - Milella, Michele

AU - Nisticò, Cecilia

AU - Ruggeri, Enzo M.

AU - Sperduti, Isabella

AU - Bracarda, Sergio

AU - Pinnarò, Paola

AU - Lanzetta, Gaetano

AU - Muti, Paola

AU - Cognetti, Francesco

AU - Carlini, Paolo

PY - 2010/12/9

Y1 - 2010/12/9

N2 - Background: Hormone therapy plus radiotherapy significantly decreases recurrences and mortality of patients affected by locally advanced prostate cancer. In order to determine if difference exists according to the hormonal treatment duration, a literature-based meta-analysis was performed.Methods: Relative risks (RR) were derived through a random-effect model. Differences in primary (biochemical failure, BF; cancer-specific survival, CSS), and secondary outcomes (overall survival, OS; local or distant recurrence, LR/DM) were explored. Absolute differences (AD) and the number needed to treat (NNT) were calculated. Heterogeneity, a meta-regression for clinic-pathological predictors and a correlation test for surrogates were conducted.Results: Five trials (3,424 patients) were included. Patient population ranged from 267 to 1,521 patients. The longer hormonal treatment significantly improves BF (with significant heterogeneity) with an absolute benefit of 10.1%, and a non significant trend in CSS. With regard to secondary end-points, the longer hormonal treatment significantly decrease both the LR and the DM with an absolute difference of 11.7% and 11.5%. Any significant difference in OS was observed. None of the three identified clinico-pathological predictors (median PSA, range 9.5-20.35, Gleason score 7-10, 27-55% patients/trial, and T3-4, 13-77% patients/trial), did significantly affect outcomes. At the meta-regression analysis a significant correlation between the overall treatment benefit in BF, CSS, OS, LR and DM, and the length of the treatment was found (p≤0.03).Conclusions: Although with significant heterogeneity (reflecting different patient' risk stratifications), a longer hormonal treatment duration significantly decreases biochemical, local and distant recurrences, with a trend for longer cancer specific survival.

AB - Background: Hormone therapy plus radiotherapy significantly decreases recurrences and mortality of patients affected by locally advanced prostate cancer. In order to determine if difference exists according to the hormonal treatment duration, a literature-based meta-analysis was performed.Methods: Relative risks (RR) were derived through a random-effect model. Differences in primary (biochemical failure, BF; cancer-specific survival, CSS), and secondary outcomes (overall survival, OS; local or distant recurrence, LR/DM) were explored. Absolute differences (AD) and the number needed to treat (NNT) were calculated. Heterogeneity, a meta-regression for clinic-pathological predictors and a correlation test for surrogates were conducted.Results: Five trials (3,424 patients) were included. Patient population ranged from 267 to 1,521 patients. The longer hormonal treatment significantly improves BF (with significant heterogeneity) with an absolute benefit of 10.1%, and a non significant trend in CSS. With regard to secondary end-points, the longer hormonal treatment significantly decrease both the LR and the DM with an absolute difference of 11.7% and 11.5%. Any significant difference in OS was observed. None of the three identified clinico-pathological predictors (median PSA, range 9.5-20.35, Gleason score 7-10, 27-55% patients/trial, and T3-4, 13-77% patients/trial), did significantly affect outcomes. At the meta-regression analysis a significant correlation between the overall treatment benefit in BF, CSS, OS, LR and DM, and the length of the treatment was found (p≤0.03).Conclusions: Although with significant heterogeneity (reflecting different patient' risk stratifications), a longer hormonal treatment duration significantly decreases biochemical, local and distant recurrences, with a trend for longer cancer specific survival.

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