RADICALS - Radiotherapy and Androgen Deprivation In Combination After Local Surgery

NCT ID: NCT00541047

Last Updated: 2023-11-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

4236 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-11-30

Study Completion Date

2022-07-27

Brief Summary

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RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Androgens can cause the growth of prostate cancer cells. Androgen deprivation therapy, such as goserelin, leuprolide, or bicalutamide, may lessen the amount of androgens made by the body. Giving radiation therapy together with androgen deprivation therapy may kill more prostate cancer cells.

PURPOSE: This randomized phase III trial is studying how well giving radiation therapy together with androgen deprivation therapy works in treating patients who have undergone surgery for prostate cancer.

Detailed Description

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OBJECTIVES:

* Assess the timing of radiotherapy and the use of hormone therapy in conjunction with post-operative radiotherapy.
* Determine the impact of radiotherapy on general quality of life, sexual function, urinary function, and bowel function.
* Determine the impact of duration of hormone therapy on general quality of life and sexual function.

OUTLINE: This is a multicenter study. Patients requiring immediate radiotherapy (RT) are assigned to arm I; patients do not require immediate RT are assigned to arm II. Patients for whom the need of immediate post-operative radiotherapy are uncertain undergo radiotherapy timing randomization within 3 months after surgery and are randomized to 1 of 2 radiotherapy arms.

* Arm I (immediate RT): Within 2 months after randomization, patients undergo radiotherapy to the prostate bed once a day, 5 days a week, for 4 (20 fractions total) or 6.5 weeks (33 fractions total). They may also undergo radiotherapy to the pelvic lymph nodes once a day, 5 days a week, for 4.5 weeks (23 fractions total) at the investigator's discretion.
* Arm II (early salvage RT in case of PSA failure): Within 2 months of confirmation of post-operative biochemical failure, patients undergo radiotherapy as in arm I.

Patients undergoing immediate RT and patients who eventually need early salvage RT undergo hormone therapy duration randomization before the administration of post-operative radiotherapy. Patients are randomized to 1 of 3 hormone therapy arms.

* Arm III (no hormone therapy): Patients do not receive hormone therapy. They receive post-operative RT alone as described above in arm I or II.
* Arm IV (RT and short-term hormone therapy): Beginning approximately 2 months prior to the start of RT, patients receive hormone therapy for 6 months. Hormone therapy\* may comprise of LHRH agonist (gonadotrophin-releasing hormone analogue \[GnRHa\] \[e.g., goserelin or leuprolide acetate\]) or bicalutamide daily.
* Arm V (RT and long-term hormone therapy): Beginning approximately 2 months prior to the start of RT, patients receive hormone therapy for 24 months. Hormone therapy\* may comprise of LHRH agonist (gonadotrophin-releasing hormone analogue \[GnRHa\] \[e.g., goserelin or leuprolide acetate\]) or bicalutamide daily.

NOTE: \*For Canadian patients, hormonal therapy will consist of LHRH analog (leuprolide acetate) therapy only.

Treatment continues in the absence of disease progression or unacceptable toxicity. Quality of life is assessed using self-administered questionnaires at baseline and 1, 5, and 10 years after randomization. Health economics information is also collected via patient-administered questionnaires (EQ-5D) at baseline and at 1, 5 and 10 years after randomization.

After completion of study treatment, patients are followed for 7 years.

Conditions

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Gastrointestinal Complications Prostate Cancer Sexual Dysfunction Urinary Complications

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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RADICALS-RT: Early RT

Group Type EXPERIMENTAL

adjuvant therapy

Intervention Type PROCEDURE

quality-of-life assessment

Intervention Type PROCEDURE

radiation therapy

Intervention Type RADIATION

RADICALS-RT: Salvage RT

Group Type EXPERIMENTAL

adjuvant therapy

Intervention Type PROCEDURE

quality-of-life assessment

Intervention Type PROCEDURE

radiation therapy

Intervention Type RADIATION

RADICALS-HD: Radiotherapy Alone

Group Type EXPERIMENTAL

adjuvant therapy

Intervention Type PROCEDURE

radiation therapy

Intervention Type RADIATION

RADICALS-HD: Radiotherapy + 6 months

Group Type EXPERIMENTAL

bicalutamide

Intervention Type DRUG

goserelin acetate

Intervention Type DRUG

leuprolide acetate

Intervention Type DRUG

adjuvant therapy

Intervention Type PROCEDURE

radiation therapy

Intervention Type RADIATION

RADICALS-HD: Radiotherapy + 24 months

Group Type EXPERIMENTAL

bicalutamide

Intervention Type DRUG

goserelin acetate

Intervention Type DRUG

leuprolide acetate

Intervention Type DRUG

adjuvant therapy

Intervention Type PROCEDURE

radiation therapy

Intervention Type RADIATION

Interventions

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bicalutamide

Intervention Type DRUG

goserelin acetate

Intervention Type DRUG

leuprolide acetate

Intervention Type DRUG

adjuvant therapy

Intervention Type PROCEDURE

quality-of-life assessment

Intervention Type PROCEDURE

radiation therapy

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of nonmetastatic adenocarcinoma of the prostate
* Must have undergone radical prostatectomy
* Post-operative serum prostate-specific antigen (PSA) \< 0.4 ng/mL
* No post-operative biochemical failure, defined as EITHER two consecutive rises in PSA and final PSA \> 0.1 ng/mL OR three consecutive rises in PSA (for patients undergoing hormone therapy duration randomization)


* See Disease Characteristics
* Co-enrollment to other trials is permitted, providing this does not interfere with the outcome measures
* 5-α reductase inhibitors, soya, selenium, and vitamin E are acceptable non-trial therapies

Exclusion Criteria

* Known distant metastases from prostate cancer
* PSA \> 5 ng/mL at the time of hormone randomization (for patients undergoing hormone therapy duration randomization)

PATIENT CHARACTERISTICS:

* No other active malignancy likely to interfere with protocol treatment or follow-up

PRIOR CONCURRENT THERAPY:


* Prior hormone therapy
* Bilateral orchidectomy
* Prior pelvic radiotherapy
* Neoadjuvant treatment
* Other concurrent therapies for prostate cancer (e.g., estrogens or cytotoxic chemotherapy) prior to disease progression
Minimum Eligible Age

0 Years

Maximum Eligible Age

120 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Canadian Cancer Trials Group

NETWORK

Sponsor Role collaborator

University College, London

OTHER

Sponsor Role lead

Responsible Party

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Cheryl Pugh

Clinical Project Manager

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Christopher Parker, MD

Role: STUDY_CHAIR

Royal Marsden NHS Foundation Trust

Locations

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British Columbia Cancer Agency - Centre for the Southern Interior

Kelowna, British Columbia, Canada

Site Status

British Columbia Cancer Agency - Vancouver Cancer Centre

Vancouver, British Columbia, Canada

Site Status

London Regional Cancer Program at London Health Sciences Centre

London, Ontario, Canada

Site Status

Ottawa Health Research Institute

Ottawa, Ontario, Canada

Site Status

Princess Margaret Hospital

Toronto, Ontario, Canada

Site Status

William Harvey Hospital

Ashford, England, United Kingdom

Site Status

North Devon District Hospital

Barnstaple, England, United Kingdom

Site Status

Basingstoke and North Hampshire NHS Foundation Trust

Basingstoke, England, United Kingdom

Site Status

Queen Elizabeth Hospital at University Hospital of Birmingham NHS Trust

Birmingham, England, United Kingdom

Site Status

Royal Bournemouth Hospital

Bournemouth, England, United Kingdom

Site Status

Bradford Royal Infirmary

Bradford, England, United Kingdom

Site Status

Southmead Hospital

Bristol, England, United Kingdom

Site Status

Bristol Haematology and Oncology Centre

Bristol, England, United Kingdom

Site Status

Addenbrooke's Hospital

Cambridge, England, United Kingdom

Site Status

Kent and Canterbury Hospital

Canterbury, England, United Kingdom

Site Status

Walsgrave Hospital

Coventry, England, United Kingdom

Site Status

Mid Cheshire Hospitals Trust- Leighton Hopsital

Crewe, England, United Kingdom

Site Status

Mayday University Hospital

Croydon, England, United Kingdom

Site Status

Doncaster Royal Infirmary

Doncaster, England, United Kingdom

Site Status

Dorset County Hospital

Dorchester, England, United Kingdom

Site Status

Royal Devon and Exeter Hospital

Exeter, England, United Kingdom

Site Status

St. Luke's Cancer Centre at Royal Surrey County Hospital

Guildford, England, United Kingdom

Site Status

Princess Alexandra Hospital

Harlow, England, United Kingdom

Site Status

Ipswich Hospital

Ipswich, England, United Kingdom

Site Status

Leeds Cancer Centre at St. James's University Hospital

Leeds, England, United Kingdom

Site Status

Lincoln County Hospital

Lincoln, England, United Kingdom

Site Status

Helen Rollason Cancer Care Centre at North Middlesex Hospital

London, England, United Kingdom

Site Status

University College Hospital

London, England, United Kingdom

Site Status

Guy's Hospital

London, England, United Kingdom

Site Status

Royal Marsden - London

London, England, United Kingdom

Site Status

Maidstone Hospital

Maidstone, England, United Kingdom

Site Status

Clatterbridge Centre for Oncology

Manchester, England, United Kingdom

Site Status

Christie Hospital

Manchester, England, United Kingdom

Site Status

James Cook University Hospital

Middlesbrough, England, United Kingdom

Site Status

Mount Vernon Cancer Centre at Mount Vernon Hospital

Northwood, England, United Kingdom

Site Status

Derriford Hospital

Plymouth, England, United Kingdom

Site Status

Dorset Cancer Centre

Poole Dorset, England, United Kingdom

Site Status

Queen's Hospital

Romford, England, United Kingdom

Site Status

Rotherham General Hospital

Rotherham, England, United Kingdom

Site Status

Hope Hospital

Salford, England, United Kingdom

Site Status

Cancer Research Centre at Weston Park Hospital

Sheffield, England, United Kingdom

Site Status

Southampton General Hospital

Southampton, England, United Kingdom

Site Status

Stepping Hill Hospital

Stockport, England, United Kingdom

Site Status

University Hospital of North Staffordshire

Stoke-on-Trent, England, United Kingdom

Site Status

Royal Marsden - Surrey

Sutton, England, United Kingdom

Site Status

Torbay Hospital

Torquay, England, United Kingdom

Site Status

Hillingdon Hospital

Uxbridge, England, United Kingdom

Site Status

Southend University Hospital NHS Foundation Trust

Westcliff-on-Sea, England, United Kingdom

Site Status

Cancer Care Centre at York Hospital

York, England, United Kingdom

Site Status

Aberdeen Royal Infirmary

Aberdeen, Scotland, United Kingdom

Site Status

Ayr Hospital

Ayr, Scotland, United Kingdom

Site Status

Edinburgh Cancer Centre at Western General Hospital

Edinburgh, Scotland, United Kingdom

Site Status

Beatson West of Scotland Cancer Centre

Glasgow, Scotland, United Kingdom

Site Status

Pinderfields General Hospital

Wakefield, Scotland, United Kingdom

Site Status

Glan Clwyd Hospital

Bodelwyddan, Wales, United Kingdom

Site Status

Velindre Cancer Center at Velindre Hospital

Cardiff, Wales, United Kingdom

Site Status

University Hospital of Wales

Cardiff, Wales, United Kingdom

Site Status

Royal Gwent Hospital

Newport, Wales, United Kingdom

Site Status

Countries

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Canada United Kingdom

References

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Parker CC, Clarke NW, Catton C, Kynaston H, Cook A, Cross W, Davidson C, Goldstein C, Logue J, Maniatis C, Petersen PM, Neville P, Payne H, Persad R, Pugh C, Stirling A, Saad F, Parulekar WR, Parmar MKB, Sydes MR. RADICALS-HD: Reflections before the Results are Known. Clin Oncol (R Coll Radiol). 2022 Sep;34(9):593-597. doi: 10.1016/j.clon.2022.06.004. Epub 2022 Jul 6. No abstract available.

Reference Type RESULT
PMID: 35810050 (View on PubMed)

Parker CC, Clarke NW, Cook AD, Kynaston HG, Petersen PM, Catton C, Cross W, Logue J, Parulekar W, Payne H, Persad R, Pickering H, Saad F, Anderson J, Bahl A, Bottomley D, Brasso K, Chahal R, Cooke PW, Eddy B, Gibbs S, Goh C, Gujral S, Heath C, Henderson A, Jaganathan R, Jakobsen H, James ND, Kanaga Sundaram S, Lees K, Lester J, Lindberg H, Money-Kyrle J, Morris S, O'Sullivan J, Ostler P, Owen L, Patel P, Pope A, Popert R, Raman R, Roder MA, Sayers I, Simms M, Wilson J, Zarkar A, Parmar MKB, Sydes MR. Timing of radiotherapy after radical prostatectomy (RADICALS-RT): a randomised, controlled phase 3 trial. Lancet. 2020 Oct 31;396(10260):1413-1421. doi: 10.1016/S0140-6736(20)31553-1. Epub 2020 Sep 28.

Reference Type RESULT
PMID: 33002429 (View on PubMed)

Vale CL, Fisher D, Kneebone A, Parker C, Pearse M, Richaud P, Sargos P, Sydes MR, Brawley C, Brihoum M, Brown C, Chabaud S, Cook A, Forcat S, Fraser-Browne C, Latorzeff I, Parmar MKB, Tierney JF; ARTISTIC Meta-analysis Group. Adjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: a prospectively planned systematic review and meta-analysis of aggregate data. Lancet. 2020 Oct 31;396(10260):1422-1431. doi: 10.1016/S0140-6736(20)31952-8. Epub 2020 Sep 28.

Reference Type RESULT
PMID: 33002431 (View on PubMed)

Parker CC, Clarke NW, Cook AD, Kynaston H, Catton CN, Cross WR, Petersen PM, Persad RA, Saad F, Bower LC, Logue J, Payne H, Forcat S, Goldstein C, Murphy C, Anderson J, Barkati M, Bottomley DM, Branagan J, Choudhury A, Chung PWM, Cogley L, Goh CL, Hoskin P, Khoo V, Malone SC, Masters L, Morris SL, Nabid A, Ong AD, Raman R, Tarver KL, Tree AC, Worlding J, Wylie JP, Zarkar AM, Parulekar WR, Parmar MKB, Sydes MR; RADICALS investigators. Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial. Lancet. 2024 Jun 1;403(10442):2405-2415. doi: 10.1016/S0140-6736(24)00548-8. Epub 2024 May 16.

Reference Type DERIVED
PMID: 38763154 (View on PubMed)

Parker CC, Kynaston H, Cook AD, Clarke NW, Catton CN, Cross WR, Petersen PM, Persad RA, Pugh CA, Saad F, Logue J, Payne H, Bower LC, Brawley C, Rauchenberger M, Barkati M, Bottomley DM, Brasso K, Chung HT, Chung PWM, Conroy R, Falconer A, Ford V, Goh CL, Heath CM, James ND, Kim-Sing C, Kodavatiganti R, Malone SC, Morris SL, Nabid A, Ong AD, Raman R, Rodda S, Wells P, Worlding J, Parulekar WR, Parmar MKB, Sydes MR; RADICALS investigators. Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial. Lancet. 2024 Jun 1;403(10442):2416-2425. doi: 10.1016/S0140-6736(24)00549-X. Epub 2024 May 16.

Reference Type DERIVED
PMID: 38763153 (View on PubMed)

Parker CC, Petersen PM, Cook AD, Clarke NW, Catton C, Cross WR, Kynaston H, Parulekar WR, Persad RA, Saad F, Bower L, Durkan GC, Logue J, Maniatis C, Noor D, Payne H, Anderson J, Bahl AK, Bashir F, Bottomley DM, Brasso K, Capaldi L, Chung C, Cooke PW, Donohue JF, Eddy B, Heath CM, Henderson A, Henry A, Jaganathan R, Jakobsen H, James ND, Joseph J, Lees K, Lester J, Lindberg H, Makar A, Morris SL, Oommen N, Ostler P, Owen L, Patel P, Pope A, Popert R, Raman R, Ramani V, Roder A, Sayers I, Simms M, Srinivasan V, Sundaram S, Tarver KL, Tran A, Wells P, Wilson J, Zarkar AM, Parmar MKB, Sydes MR; RADICALS investigators. Timing of radiotherapy (RT) after radical prostatectomy (RP): long-term outcomes in the RADICALS-RT trial (NCT00541047). Ann Oncol. 2024 Jul;35(7):656-666. doi: 10.1016/j.annonc.2024.03.010. Epub 2024 Apr 5.

Reference Type DERIVED
PMID: 38583574 (View on PubMed)

Other Identifiers

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MRC-RADICALS-PR10

Identifier Type: OTHER

Identifier Source: secondary_id

ISRCTN40814031

Identifier Type: REGISTRY

Identifier Source: secondary_id

2006-000205-34

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

NCT00541047

Identifier Type: OTHER

Identifier Source: secondary_id

00316/0223/001-0001

Identifier Type: OTHER

Identifier Source: secondary_id

PR13

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

CDR0000571528

Identifier Type: -

Identifier Source: org_study_id

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