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Open Access Highly Accessed Research article

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

Federica Cuppone1, Emilio Bria1*, Diana Giannarelli2, Vanja Vaccaro1, Michele Milella1, Cecilia Nisticò1, Enzo Maria Ruggeri3, Isabella Sperduti2, Sergio Bracarda6, Paola Pinnarò1, Gaetano Lanzetta4, Paola Muti5, Francesco Cognetti1 and Paolo Carlini1

Author Affiliations

1 Department of Medical Oncology, Regina Elena National Cancer Institute, Roma, Italy

2 Biostatistics, Regina Elena National Cancer Institute, Roma, Italy

3 Medical Oncology, Ospedale 'Belcolle', Viterbo, Italy

4 Clinical Oncology Unit, Istituto Neurotraumatologico Italiano (I.N.I.), Grottaferrata, Rome, Italy

5 Scientiphic Direction, Regina Elena National Cancer Institute, Roma, Italy

6 Medical Oncology, Ospedale San Donato, Arezzo, Italy

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BMC Cancer 2010, 10:675  doi:10.1186/1471-2407-10-675

Published: 9 December 2010

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.