@article{discovery10157968,
            note = {Creative Commons Attribution Non-Commercial No Derivatives 4.0 License: https://creativecommons.org/licenses/by-nc-nd/4.0/},
           month = {October},
         journal = {Journal of Clinical Oncology},
            year = {2022},
           title = {Sequencing of Androgen-Deprivation Therapy of Short Duration With Radiotherapy for Nonmetastatic Prostate Cancer (SANDSTORM): A Pooled Analysis of 12 Randomized Trials},
       publisher = {American Society of Clinical Oncology (ASCO)},
             url = {https://doi.org/10.1200/JCO.22.00970},
        abstract = {PURPOSE: The sequencing of androgen-deprivation therapy (ADT) with radiotherapy (RT) may affect outcomes for prostate cancer in an RT-field size-dependent manner. Herein, we investigate the impact of ADT sequencing for men receiving ADT with prostate-only RT (PORT) or whole-pelvis RT (WPRT). MATERIALS AND METHODS: Individual patient data from 12 randomized trials that included patients receiving neoadjuvant/concurrent or concurrent/adjuvant short-term ADT (4-6 months) with RT for localized disease were obtained from the Meta-Analysis of Randomized trials in Cancer of the Prostate consortium. Inverse probability of treatment weighting (IPTW) was performed with propensity scores derived from age, initial prostate-specific antigen, Gleason score, T stage, RT dose, and mid-trial enrollment year. Metastasis-free survival (primary end point) and overall survival (OS) were assessed by IPTW-adjusted Cox regression models, analyzed independently for men receiving PORT versus WPRT. IPTW-adjusted Fine and Gray competing risk models were built to evaluate distant metastasis (DM) and prostate cancer-specific mortality. RESULTS: Overall, 7,409 patients were included (6,325 neoadjuvant/concurrent and 1,084 concurrent/adjuvant) with a median follow-up of 10.2 years (interquartile range, 7.2-14.9 years). A significant interaction between ADT sequencing and RT field size was observed for all end points (P interaction {\ensuremath{<}} .02 for all) except OS. With PORT (n = 4,355), compared with neoadjuvant/concurrent ADT, concurrent/adjuvant ADT was associated with improved metastasis-free survival (10-year benefit 8.0\%, hazard ratio [HR], 0.65; 95\% CI, 0.54 to 0.79; P {\ensuremath{<}} .0001), DM (subdistribution HR, 0.52; 95\% CI, 0.33 to 0.82; P = .0046), prostate cancer-specific mortality (subdistribution HR, 0.30; 95\% CI, 0.16 to 0.54; P {\ensuremath{<}} .0001), and OS (HR, 0.69; 95\% CI, 0.57 to 0.83; P = .0001). However, in patients receiving WPRT (n = 3,049), no significant difference in any end point was observed in regard to ADT sequencing except for worse DM (HR, 1.57; 95\% CI, 1.20 to 2.05; P = .0009) with concurrent/adjuvant ADT. CONCLUSION: ADT sequencing exhibits a significant impact on clinical outcomes with a significant interaction with field size. Concurrent/adjuvant ADT should be the standard of care where short-term ADT is indicated in combination with PORT.},
            issn = {0732-183X},
          author = {Ma, Ting Martin and Sun, Yilun and Malone, Shawn and Roach, Mack and Dearnaley, David and Pisansky, Thomas M and Feng, Felix Y and Sandler, Howard M and Efstathiou, Jason A and Syndikus, Isabel and Hall, Emma C and Tree, Alison C and Sydes, Matthew R and Cruickshank, Claire and Roy, Soumyajit and Bolla, Michel and Maingon, Philippe and De Reijke, Theo and Nabid, Abdenour and Carrier, Nathalie and Souhami, Luis and Zapatero, Almudena and Guerrero, Araceli and Alvarez, Ana and Gonzalez San-Segundo, Carmen and Maldonado, Xavier and Romero, Tahmineh and Steinberg, Michael L and Valle, Luca F and Rettig, Matthew B and Nickols, Nicholas G and Shoag, Jonathan E and Reiter, Robert E and Zaorsky, Nicholas G and Jia, Angela Y and Garcia, Jorge A and Spratt, Daniel E and Kishan, Amar U and Meta-Analysis of Randomized Trials in Cancer of the Prostate (MA, {}}
}