clickable:
Effect of Chemotherapy With Docetaxel With Androgen Suppression and Radiotherapy for Localized High-Risk Prostate Cancer: The Randomized Phase III NRG Oncology RTOG 0521 TrialInteresting, though I wish there was a subgroup analysis for Gleason Grade Group 5, the G9/10 cases. There has been speculation that high grade (G9/10) cases are less responsive to ADT and additions up front like chemotherapy would be more effective for them. This study seems to have all the pieces to examine that, but they left the results lumped together for the entire cohort. They only separated out the with vs without chemo split, for the whole group. Maybe I'm just missing it.
I wonder if the G9/10 group would show more, or less, improvement? The lack of this analysis is typical, and a frustrating aspect of the vast majority of studies. It's surprising with this one since about
50% of the cases were G9/10. It seems they could easily have done that.
Of note also, as with most studies involving RT the doses are below what is commonly used today. 72-76 Gy was typical, though with today's precision methods for IGRT they use 79.2 - 81.0 or so. With BT added, the effective dose to the prostate is even higher. So adding some of these treatments may be less effective today since the initial RT is more effective than it used to be. I wonder if that may be why the NCCN Prostate Cancer Guideline has removed the docetaxel recommendation in their latest (1.2019) issue? Just speculating there, to be clear.
We sure face difficult choices in our treatment options. There are known side-effect risks with chemo treatment, and we hope there is improved survival resulting from taking those risks.