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

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

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

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Endless love

An exhibtion of paintings and installation, as well as a performance of Security, 2023, during Berlin Art Wee

Grace and harmony (live)

In Grace and Harmony Thomasson is joined by a small group of performers for a musical theatre experiment. The work uses song and dance to describe the fantasy and sometimes awkward reality of trying to gracefully move in and out of social encounters. Having learnt the song and dance routine separately, they come together in public to perform for the first time, and do their best to move in time and sing in harmony. Performers: Federico Hewson, Anna Holmes, Jos McKain, Shade Théret, Stanley Weissoh

Other People

'Other People' uses painting, theatre-making and video to describe how exchanges are staged between individuals. This two-part project incorporates the public presentation of a one-act play and an exhibition, and continues my investigation into how stories are shared on camera, on stage and in everyday life. Looking specifically at instances in which people voluntarily allow themselves to be used by other people, this project focuses on how individuals behave in mutually beneficial relationships and how this behaviour might be useful in understanding exchanges between performer and audience. The first part of the project was staged at David Roberts Art Foundation, London, in March 2016. The performance studio there shifted between rehearsal studio, video set and theatre, as a group of actors developed and performed songs and narratives by the artist on a constructed set, first for camera, and then for a live audience. This period of the project culminated in the presentation of a one-act play 'Volunteers'. The second part of the project was an exhibition, Other People, presented at Southard Reid, London in September 2016. The exhibition included drawings made throughout the project alongside Pressure, 2016, a video that was constructed and recorded on the set of the play at David Roberts Art Foundation. The video employs text and song to describe three fictional situations in which people voluntarily allow themselves to be used by other people

Public Relations

Developed during a month-long residency at Site Gallery, Sheffield, and later performed at Maureen Paley, London; Public Relations is a choreographed group action that looks at how movement is used when language fails or seems hard to summon. The work sees a group of performers playing movement based games in an attempt to negotiate collective feelings of social discomfort. This work continues Beech and Thomasson’s investigation into how double standards are performed and upheld collectively. A group of performers present the audience with a series of movements that systematically come together as component parts of a stage combat sequence. The group collectively performs and records a Foley soundscape, which then underscores the series of violent interactions that follow. Through the repetition of a short sequence of movements and the activation of their clothes and water bottles, the work suggests therapeutic potentials in staging violence without touching. In Sheffield Lucy Beech and Edward Thomasson worked with a group of performers – Jowanna Rose, Sam Holland, Megan Gibson and Heather Morgan – to explore the notion that a problem shared is a problem solved. The development of the work was presented in the gallery as a game-like process of learning and repeating. The residency culminated in a series of final performances at the end of the residency on 6 February 2016. Following these initial performances in Sheffield, the work as restaged at Maureen Paley, London on 27 February 2016. This iteration of the work was performed by four male performers – Rob Crosse, Sam Holland, Timothy Taylor and Charles Stanford. Though the choreography was largely unaltered, this shift in casting allowed fresh meanings to emerge

Together

Exploring ideas of separation and independence, this a new performance project made in two parts. Developed over a three week rehearsal period, the project incorporated both live and recorded performance. Together (2017) is a new live work, was performed in the gallery. Together (Forever) (2017), its recorded companion, looped in the gallery throughout the week. Both works presented the same group of performers engaging in a movement based game. Working in couples, the group collectively construct a safe space to momentarily reject shared social standards.  The work continues mine and Beech’s collaborative work, which imagines situations in which performance is used to overcome everyday struggles. Whether live or recorded, their elaborately choreographed group performances look at how personal and occupational problems might be worked through collectively. Together (2017), was presented live in the gallery at 14.00, 14.30 and 15.00 each Saturday during the run of the exhibition. This exhibition was presented as part of the Art Now series. Art Now is a series of exhibitions at Tate Britain focusing on new and recent work by emerging artists

Grace and harmony

In Grace and Harmony Thomasson is joined by a small group of performers for a musical theatre experiment. The work uses song and dance to describe the fantasy and sometimes awkward reality of trying to gracefully move in and out of social encounters. Having learnt the song and dance routine separately, they come together in public to perform for the first time, and do their best to move in time and sing in harmony

ENGINEERING AND GINNING Effect of Machine-Fiber Interaction on Cotton Fiber Quality and Foreign-Matter Particle Attachment to Fiber

AbstRACt Changes in cotton fiber quality and attachment forces between foreign-matter particles and fibers were studied at different stages from the time of harvest through lint cleaning to develop new and less damaging methods for removing foreign-matter particles from cotton fiber. The study involved 75 samples collected from five field locations near College station, texas, including three replications and five harvesting and processing treatments: (1) hand picked and hand ginned, (2) machine picked and hand ginned, (3) machine picked, seed-cotton cleaned, and hand ginned, (4) machine picked, seed-cotton cleaned, and machine ginned, and (5) machine picked, seed-cotton cleaned, machine ginned, and onestage lint-cleaned. A microscope was used to identify foreign-matter particles in each sample. Physical characteristics of the particles and their attachment to fibers were investigated and classified. Results indicated that each machine-fiber interaction during the harvesting through ginning process had the net effect of decreasing the size of foreign-matter particles. The particles had no obvious difference in shape across the processing stages. The tightness of particle-fiber attachment, the number of neps, and the short-fiber content differed significantly as a function of mechanical interactions: they increased as the number of mechanical interactions increased. Processing through the gin stand was a major contributor to the increase in short fiber content. The majority of the foreign-matter particles were leaves, but proportions of the particle categories changed with stages of processing. With an increased number of mechanical interactions the proportion of leaf particles decreased and the proportion of seedcoat fragments and stems increased