Recently, results from NRG/RTOG 0924, the largest randomized trial to evaluate the benefit of whole-pelvic radiotherapy (WPRT) in localized prostate cancer, were presented. We conducted an aggregate meta-analysis of all phase III randomized trials to determine the impact of WPRT on oncologic outcomes.
Pubmed via MEDLINE, clinicaltrials.gov, and conference proceedings were systematically searched for randomized trials of ± WPRT in localized prostate cancer conducted between 1980-2025. Random-effects models were utilized to generate pooled hazard ratios (HR) with 95% confidence intervals (CI). Heterogeneity was assessed with I² statistics and leave-one-out sensitivity analyses were performed. Meta-regression was performed to assess the influence of the proportion of patients with Gleason Score 7-10, utilization of androgen deprivation therapy, radiotherapy dose, and field size. Endpoints assessed included overall survival (OS), a biochemical-based endpoint, referred to as biochemical recurrence (BCR), and distant metastasis (DM).
Four randomized trials were identified (n=4,465 patients), including three multi-center cooperative group trials (GETUG-AFU-01, RTOG 9413, RTOG 0924) and one single institution trial (POP-RT). WPRT did not improve OS (HR 1.05, 95%CI 0.95-1.16; I²=0%), BCR (HR 0.82, 95%CI 0.63-1.07; I²=76%), or DM (HR 0.88, 95% CI 0.58-1.34; I²=68%). The high rates of heterogeneity observed were due primarily from the POP-RT trial. On sensitivity analyses excluding POP-RT heterogeneity was eliminated (HR for BCR was 0.91 (95%CI 0.81-1.02; I²=0%; HR for DM was 1.06 (95%CI 0.87-1.29; I²=0%). Meta-regression found no significant modifying effect of any co-variables assessed.
This aggregate meta-analysis did not demonstrate any meaningful benefit of WPRT over prostate-only radiotherapy in unselected localized prostate cancer. Individual patient data meta-analysis is warranted to understand if any subgroup consistently derives benefit from WPRT.
International journal of radiation oncology, biology, physics. 2026 May 22 [Epub ahead of print]
Soumyajit Roy, Angela Y Jia, Nicholas G Zaorsky, Daniel E Spratt
Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH. Electronic address: ., Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH., Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH. Electronic address: .