A highly respected group of authors has just published a paper that has us beat!
Porter et al. have reported the results of a restrospective analysis designed to investigate the effect of adjuvant external beam radiotherapy (EBRT) on the rate of cancer-specific and overall survival after radical prostatectomy (RP) in patients with a long-term follow-up.
Now we know that there is controversy about the benefit of adjuvant EBRT after RP for prostate cancer when endpoints beyond biochemical and local recurrence are considered, but we are uncertain exactly what this paper adds to the discussion.
The authors analyzed data from a cohort of 752 patients treated with RP, of whom 118 (15.7 percent) received adjuvant EBRT. These 118 patients were matched with controls who did not receive adjuvant EBRT after RP. Exact matches were made for pT stage, post-surgical Gleason score, surgical margin status, age (±10 years), year of surgery (±10 years), and the use of hormonal therapy.
The authors summarize the results of their analysis as follows:
- Median follow-up was 11.4 years — but the range was vast, from about 1 month to 41 years.
- The 10- and 20-year overall survival after RP in those with no adjuvant EBRT were, respectively, 81.1 and 44.8 percent, as compared to 75.5 and 40.0 percent in the group of men receiving adjuvant EBRT (P = 0.1).
- The corresponding probabilities for cause-specific survival were, respectively, 97.3 and 89.0 percent compared to 86.3 and 69.3 percent (P < 0.001).
- There was no statistically significant difference in the overall and cause-specific survival between the groups after matching.
The authors conclude by stating that, “in a matched case-control study, [adjuvant EBRT] has no effect on overall and cancer-specific survival.”
What we are trying to understand is why these data are worth reporting!
The men who received adjuvant RT must have done so for a reason. In other words, there was a clinical rationale for persuading these men to have adjuvant RT immediately following surgery. Similarly, there was a clinical rationale for not persuading the men who didn’t receive adjuvant RT that they needed it.
To whatever extent one is able to “match up” patients after the fact, this is not a strictly comparative trial, and it would be misleading to come to the conclusion from these data that adjuvant radiotherapy has no long-term survival impact in carefully selected men following surgery. The extent of that survival benefit is a very different issue. It might not be much. And in that case there are good grounds for a careful risk/benefit analysis to determine the peerception of value for any individual patient. It could even be zero, and then we could fuggedabahtdit. But thjis study doesn’t give us that level of data or confidence.
It would require a large, long-term, randomized, multicenter trial to resolve this issue. The cost would likely be prohibitive, and the likelihood of high enrollment in such a trial is minimal. Frankly, we doubt that such a trial would ever be implemented.
A highly respected group of authors has just published a paper that has us beat!
Porter et al. have reported the results of a restrospective analysis designed to investigate the effect of adjuvant external beam radiotherapy (EBRT) on the rate of cancer-specific and overall survival after radical prostatectomy (RP) in patients with a long-term follow-up.
Now we know that there is controversy about the benefit of adjuvant EBRT after RP for prostate cancer when endpoints beyond biochemical and local recurrence are considered, but we are uncertain exactly what this paper adds to the discussion.
The authors analyzed data from a cohort of 752 patients treated with RP, of whom 118 (15.7 percent) received adjuvant EBRT. These 118 patients were matched with controls who did not receive adjuvant EBRT after RP. Exact matches were made for pT stage, post-surgical Gleason score, surgical margin status, age (±10 years), year of surgery (±10 years), and the use of hormonal therapy.
The authors summarize the results of their analysis as follows:
The authors conclude by stating that, “in a matched case-control study, [adjuvant EBRT] has no effect on overall and cancer-specific survival.”
What we are trying to understand is why these data are worth reporting!
The men who received adjuvant RT must have done so for a reason. In other words, there was a clinical rationale for persuading these men to have adjuvant RT immediately following surgery. Similarly, there was a clinical rationale for not persuading the men who didn’t receive adjuvant RT that they needed it.
To whatever extent one is able to “match up” patients after the fact, this is not a strictly comparative trial, and it would be misleading to come to the conclusion from these data that adjuvant radiotherapy has no long-term survival impact in carefully selected men following surgery. The extent of that survival benefit is a very different issue. It might not be much. And in that case there are good grounds for a careful risk/benefit analysis to determine the peerception of value for any individual patient. It could even be zero, and then we could fuggedabahtdit. But thjis study doesn’t give us that level of data or confidence.
It would require a large, long-term, randomized, multicenter trial to resolve this issue. The cost would likely be prohibitive, and the likelihood of high enrollment in such a trial is minimal. Frankly, we doubt that such a trial would ever be implemented.
Filed under: Uncategorized | Tagged: adjuvant, prostatectomy, radiotherapy, survival
A highly respected group of authors has just published a paper that has us beat!
Porter et al. have reported the results of a restrospective analysis designed to investigate the effect of adjuvant external beam radiotherapy (EBRT) on the rate of cancer-specific and overall survival after radical prostatectomy (RP) in patients with a long-term follow-up.
Now we know that there is controversy about the benefit of adjuvant EBRT after RP for prostate cancer when endpoints beyond biochemical and local recurrence are considered, but we are uncertain exactly what this paper adds to the discussion.
The authors analyzed data from a cohort of 752 patients treated with RP, of whom 118 (15.7 percent) received adjuvant EBRT. These 118 patients were matched with controls who did not receive adjuvant EBRT after RP. Exact matches were made for pT stage, post-surgical Gleason score, surgical margin status, age (±10 years), year of surgery (±10 years), and the use of hormonal therapy.
The authors summarize the results of their analysis as follows:
The authors conclude by stating that, “in a matched case-control study, [adjuvant EBRT] has no effect on overall and cancer-specific survival.”
What we are trying to understand is why these data are worth reporting!
The men who received adjuvant RT must have done so for a reason. In other words, there was a clinical rationale for persuading these men to have adjuvant RT immediately following surgery. Similarly, there was a clinical rationale for not persuading the men who didn’t receive adjuvant RT that they needed it.
To whatever extent one is able to “match up” patients after the fact, this is not a strictly comparative trial, and it would be misleading to come to the conclusion from these data that adjuvant radiotherapy has no long-term survival impact in carefully selected men following surgery. The extent of that survival benefit is a very different issue. It might not be much. And in that case there are good grounds for a careful risk/benefit analysis to determine the peerception of value for any individual patient. It could even be zero, and then we could fuggedabahtdit. But thjis study doesn’t give us that level of data or confidence.
It would require a large, long-term, randomized, multicenter trial to resolve this issue. The cost would likely be prohibitive, and the likelihood of high enrollment in such a trial is minimal. Frankly, we doubt that such a trial would ever be implemented.