The Absolute Effect / Evidence / RTOG 85-31
Prostate Cancer · Radiation · Unfavorable / locally advanced
RTOG 85-31
Clinical question
Does immediate long-term androgen suppression after definitive RT improve survival compared with starting hormonal therapy only at relapse?
Trial context
Population
977 men
Intervention
Definitive RT (44–46 Gy pelvis + 20–25 Gy prostate boost) plus goserelin begun during final week of RT and continued indefinitely/until progression.
Comparator
RT with deferred hormonal therapy at relapse
Primary / key evidence
10-y OS 49% vs 39%; absolute +10 pp; p=.002. 10-y local failure 23% vs 38%; distant metastasis 24% vs 39%.
Absolute Effect
What changes for patients?
10-y OS 49% vs 39%; absolute +10 pp; p=.002. 10-y local failure 23% vs 38%; distant metastasis 24% vs 39%.
NNT/NNH: Not calculated unless a defensible fixed-time event-rate comparison was available in the cited primary analysis; median-survival differences alone are not converted to NNT.
Clinical interpretation
Immediate long-term androgen suppression improved survival and reduced local and distant failure in unfavorable-prognosis prostate cancer.
Limitations / maturity
Interpret the effect in the context of the trial population, endpoint definition, follow-up and treatment era. Subsequent trials and evolving standards may limit direct applicability to contemporary patients.
Primary publication
Pilepich MV et al. Int J Radiat Oncol Biol Phys. 2005.