Explore Flipsnack. Transform boring PDFs into engaging digital flipbooks. Share, engage, and track performance in the same platform.
From magazines to catalogs or private internal documents, you can make any page-flip publication look stunning with Flipsnack.
Check out examples from our customers. Digital magazines, zines, ebooks, booklets, flyers & more.
Pre-made templates to create stunning publications in minutes
Here are eight reasons why you should consider choosing interactive, digital flipbooks instead of boring and static PDFs. Check them out!
In a meta-analysis o phase III trials comparing the risks o disease progression, all-cause- and disease-specic mortality between IADT and CADT, Tsai et al ound no dierence in overall survival, but a small decline in disease-specic survival or men treated with IADT. 19 However, IADT was associated with a signicant improvement in the occurrence o hot fushes. More recently, results o two large, long-term phase III trials with homogenous patient populations were released. These companion studies were conducted to determine whether IADT was non-inerior to CADT with respect to overall and disease-specic survival in either metastatic or non-metastatic disease. The NCIC-PR7 trial enrolled 1,386 men with nonmetastatic disease and signs o PSA biochemical ailure, dened as PSA level higher than 3 ng/mL and higher than the nadir that occurred ater RT (primary or salvage post-prostatectomy). 20 IADT was given in eight-month treatment cycles, each beginning with a course o a depot LHRH analogue injection combined with a nonsteroidal antiandrogen, which was continued or a minimum o our weeks. Ater eight months, treatment was stopped i there was no evidence o clinical disease progression and i the PSA level was less than 4 ng/mL and had not increased more than 1 ng/mL above the previous value in the same treatment cycle. Therapy was resumed when PSA reached 10 ng/mL. The NCIC-PR7 trial showed conclusively that IADT was noninerior to CADT with respect to overall survival (Figure 1), resulting in general widespread agreement that IADT is at least a viable option or men with non-metastatic prostate cancer. 20 A number o QOL measures were also signicantly improved with IADT, including atigue, urinary problems, hot fashes, desire or sexual activity, and erectile dysunction. Although only 35% o patients recovered their pretreatment testosterone levels within two years o completing their rst year o treatment, 79% reached a testosterone level o 5 nmol/L or higher. Patients older than 75 years were less likely to recover their testosterone levels. The SWOG-9346 trial enrolled 1,535 men with metastatic disease. 21 Patients underwent a seven-month induction course o the LHRH analogue goserelin and the antiandrogen agent bicalutamide (or similar agents depending on the country o enrolment). Patients with stable or declining PSA levels o 4.0 ng/mL or lower at months 6 and 7 were eligible or randomization into the IADT or CADT group. All patients were assessed every three months, and patients in the IADT group resumed treatment when their PSA level rose to 20 ng/mL (or returned to baseline i their baseline PSA levels were less than 20 ng/mL). Results o the SWOG-9346 trial have been interpreted with caution, as there was a non-signicant trend suggesting a benet o CADT over IADT, with a hazard ratio o 1.10 and a 90% condence interval o 0.99 to 1.24 (in a secondary analysis, a two-sided test o the nonineriority hypothesis, similar to assessment o the 95% condence interval, produced a similar result [95% CI 0.97 to 1.25]). 21 Although non-ineriority would have required a condence interval with an upper and lower bound o 1.2 or higher, the upper bound o 1.23 has deemed the results o SWOG-9346 inconclusive. Although a 20% greater risk o death with IADT vs. CADT could not be ruled out, there were too ew events to conrm a signicant ineriority o IADT. However, the SWOG-9346 study demonstrated QOL benets o IADT, showing improved erectile unction, overall mental health and libido three months ater treatment discontinuation. When interpreting the results o the SWOG-9346 study and considering IADT or men with metastatic disease, it is important to weigh these benets against possible modest survival benets. In guidelines dating back to 2007, the American Urological Association had not yet recognized the use o IADT, 22 and ASCO stated that the evidence was insucient to support its use outside clinical trials. 23 The more current 2012 European Association o Urology guidelines no longer regard IADT as investigational, 24 asserting that any modest benet o CADT or disease progression seen in the SWOG-9346 clinical trial is oset by increased toxicity, resulting in a lack o dierence in overall survival. The recent National Comprehensive Cancer Network (NCCN) guidelines are more cautious, acknowledging that IADT may reduce side eects without altering survival compared with CADT, but that long-term ecacy o IADT remains unproven. 25 2 Reproduced with permission rom Crook JM, et al. N Engl J Med 2012;367:895-903. CADT = Continuous Androgen Deprivation IADT = Intermittent Androgen Deprivation Figure 1. Overall survival in the intent-to-treat population of the NCIC-PR7 trial. CADT IADT Overall survival (%) 100 80 90 70 60 40 30 10 50 20 0 024681012 Years since randomization Hazard ratio 1.03 (95% CI 0.87-1.22) p = 0.009
The cookies we use on Flipsnack's website help us provide a better experience for you, track how our website is used, and show you relevant advertising. If you want to learn more about the cookies we're using, make sure to check our Cookie policy
We use essential cookies to make our site work for you. These allow you to navigate and operate on our website.
We use performance cookies to understand how you interact with our site.They help us understand what content is most valued and how visitors move around the site, helping us improve the service we offer you.
We use marketing cookies to deliver ads we think you'll like.They allow us to measure the effectiveness of the ads that are relevant for you.