In:
PLOS Medicine, Public Library of Science (PLoS), Vol. 19, No. 6 ( 2022-6-7), p. e1003998-
Abstract:
STAMPEDE has previously reported that radiotherapy (RT) to the prostate improved overall survival (OS) for patients with newly diagnosed prostate cancer with low metastatic burden, but not those with high-burden disease. In this final analysis, we report long-term findings on the primary outcome measure of OS and on the secondary outcome measures of symptomatic local events, RT toxicity events, and quality of life (QoL). Methods and findings Patients were randomised at secondary care sites in the United Kingdom and Switzerland between January 2013 and September 2016, with 1:1 stratified allocation: 1,029 to standard of care (SOC) and 1,032 to SOC+RT. No masking of the treatment allocation was employed. A total of 1,939 had metastatic burden classifiable, with 42% low burden and 58% high burden, balanced by treatment allocation. Intention-to-treat (ITT) analyses used Cox regression and flexible parametric models (FPMs), adjusted for stratification factors age, nodal involvement, the World Health Organization (WHO) performance status, regular aspirin or nonsteroidal anti-inflammatory drug (NSAID) use, and planned docetaxel use. QoL in the first 2 years on trial was assessed using prospectively collected patient responses to QLQ-30 questionnaire. Patients were followed for a median of 61.3 months. Prostate RT improved OS in patients with low, but not high, metastatic burden (respectively: 202 deaths in SOC versus 156 in SOC+RT, hazard ratio (HR) = 0·64, 95% CI 0.52, 0.79, p 〈 0.001; 375 SOC versus 386 SOC+RT, HR = 1.11, 95% CI 0.96, 1.28, p = 0·164; interaction p 〈 0.001). No evidence of difference in time to symptomatic local events was found. There was no evidence of difference in Global QoL or QLQ-30 Summary Score. Long-term urinary toxicity of grade 3 or worse was reported for 10 SOC and 10 SOC+RT; long-term bowel toxicity of grade 3 or worse was reported for 15 and 11, respectively. Conclusions Prostate RT improves OS, without detriment in QoL, in men with low-burden, newly diagnosed, metastatic prostate cancer, indicating that it should be recommended as a SOC. Trial registration ClinicalTrials.gov NCT00268476 , ISRCTN.com ISRCTN78818544 .
Type of Medium:
Online Resource
ISSN:
1549-1676
DOI:
10.1371/journal.pmed.1003998
DOI:
10.1371/journal.pmed.1003998.g001
DOI:
10.1371/journal.pmed.1003998.g002
DOI:
10.1371/journal.pmed.1003998.g003
DOI:
10.1371/journal.pmed.1003998.g004
DOI:
10.1371/journal.pmed.1003998.g005
DOI:
10.1371/journal.pmed.1003998.g006
DOI:
10.1371/journal.pmed.1003998.t001
DOI:
10.1371/journal.pmed.1003998.t002
DOI:
10.1371/journal.pmed.1003998.t003
DOI:
10.1371/journal.pmed.1003998.t004
DOI:
10.1371/journal.pmed.1003998.t005
DOI:
10.1371/journal.pmed.1003998.s001
DOI:
10.1371/journal.pmed.1003998.s002
DOI:
10.1371/journal.pmed.1003998.s003
DOI:
10.1371/journal.pmed.1003998.s004
DOI:
10.1371/journal.pmed.1003998.s005
DOI:
10.1371/journal.pmed.1003998.s006
DOI:
10.1371/journal.pmed.1003998.s007
DOI:
10.1371/journal.pmed.1003998.s008
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10.1371/journal.pmed.1003998.s009
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10.1371/journal.pmed.1003998.s010
DOI:
10.1371/journal.pmed.1003998.s011
DOI:
10.1371/journal.pmed.1003998.s012
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10.1371/journal.pmed.1003998.s013
DOI:
10.1371/journal.pmed.1003998.s014
DOI:
10.1371/journal.pmed.1003998.s015
DOI:
10.1371/journal.pmed.1003998.s016
DOI:
10.1371/journal.pmed.1003998.s017
DOI:
10.1371/journal.pmed.1003998.r001
DOI:
10.1371/journal.pmed.1003998.r002
DOI:
10.1371/journal.pmed.1003998.r003
DOI:
10.1371/journal.pmed.1003998.r004
DOI:
10.1371/journal.pmed.1003998.r005
DOI:
10.1371/journal.pmed.1003998.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2164823-2
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