Advertisement

Patient-reported quality of life after stereotactic body radiation therapy versus moderate hypofractionation for clinically localized prostate cancer

Published:November 24, 2016DOI:https://doi.org/10.1016/j.radonc.2016.10.013

      Abstract

      Background and purpose

      Evaluate changes in bowel, urinary and sexual patient-reported quality of life following treatment with moderately hypofractionated radiotherapy (<5 Gray/fraction) or stereotactic body radiation therapy (SBRT;5–10 Gray/fraction) for prostate cancer.

      Materials and methods

      In a pooled multi-institutional analysis of men treated with moderate hypofractionation or SBRT, we compared minimally detectable difference in bowel, urinary and sexual quality of life at 1 and 2 years using chi-squared analysis and logistic regression.

      Results

      378 men received moderate hypofractionation compared to 534 men who received SBRT. After 1 year, patients receiving moderate hypofractionation were more likely to experience worsening in bowel symptoms (39.5%) compared to SBRT (32.5%; p = .06), with a larger difference at 2 years (37.4% versus 25.3%, p = .002). Similarly, patients receiving moderate fractionation had worsening urinary symptom score compared to patients who underwent SBRT at 1 and 2 years (34.7% versus 23.1%, p < .001; and 32.8% versus 14.0%, p < .001). There was no difference in sexual symptom score at 1 or 2 years. After adjusting for age and cancer characteristics, patients receiving SBRT were less likely to experience worsening urinary symptom scores at 2 years (odds ratio: 0.24[95%CI: 0.07–0.79]).

      Conclusions

      Patients who received SBRT or moderate hypofractionation have similar patient-reported change in bowel and sexual symptoms, although there was worse change in urinary symptoms for patients receiving moderate hypofractionation.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Radiotherapy and Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Vogelius I.R.
        • Bentzen S.M.
        Meta-analysis of the alpha/beta ratio for prostate cancer in the presence of an overall time factor: bad news, good news, or no news?.
        Int J Radiat Oncol Biol Phys. 2013; 85: 89-94
        • Hodges J.C.
        • Lotan Y.
        • Boike T.P.
        • Benton R.
        • Barrier A.
        • Timmerman R.D.
        Cost-effectiveness analysis of stereotactic body radiation therapy versus intensity-modulated radiation therapy: an emerging initial radiation treatment option for organ-confined prostate cancer.
        J Oncol Pract. 2012; 8: e31s-e37s
        • Sher D.J.
        • Parikh R.B.
        • Mays-Jackson S.
        • Punglia R.S.
        Cost-effectiveness analysis of SBRT versus IMRT for low-risk prostate cancer.
        Am J Clin Oncol. 2014; 37: 215-221
        • Arcangeli G.
        • Saracino B.
        • Gomellini S.
        • et al.
        A prospective phase III randomized trial of hypofractionation versus conventional fractionation in patients with high-risk prostate cancer.
        Int J Radiat Oncol Biol Phys. 2010; 78: 11-18
        • Arcangeli S.
        • Strigari L.
        • Gomellini S.
        • et al.
        Updated results and patterns of failure in a randomized hypofractionation trial for high-risk prostate cancer.
        Int J Radiat Oncol Biol Phys. 2012; 84: 1172-1178
        • Dearnaley D.
        • Syndikus I.
        • Sumo G.
        • et al.
        Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: preliminary safety results from the CHHiP randomised controlled trial.
        Lancet Oncol. 2012; 13: 43-54
        • Hoffman K.E.
        • Voong K.R.
        • Pugh T.J.
        • et al.
        Risk of late toxicity in men receiving dose-escalated hypofractionated intensity modulated prostate radiation therapy: results from a randomized trial.
        Int J Radiat Oncol Biol Phys. 2014; 88: 1074-1084
        • Pollack A.
        • Walker G.
        • Horwitz E.M.
        • et al.
        Randomized trial of hypofractionated external-beam radiotherapy for prostate cancer.
        J Clin Oncol. 2013; 31: 3860-3868
        • Group R.T.O.
        RTOG 0415: a phase III randomized study of hypofractionated 3D-CRT/IMRT versus conventionally fractionated 3D-CRT/IMRT in patients with favorable risk prostate cancer.
        2008
        • Kuban D.
        • Nogueras-Gonzalez G.
        • Hamblin L.
        • et al.
        Preliminary report of a randomized dose escalation trial for prostate cancer using hypofractionation.
        Int J Radiat Oncol Biol Phys. 2010; 78: S58-S59
        • Aluwini S.
        • van Rooij P.
        • Hoogeman M.
        • Kirkels W.
        • Kolkman-Deurloo I.K.
        • Bangma C.
        Stereotactic body radiotherapy with a focal boost to the MRI-visible tumor as monotherapy for low- and intermediate-risk prostate cancer: early results.
        Radiat Oncol. 2013; 8: 84
        • Bolzicco G.
        • Favretto M.S.
        • Satariano N.
        • Scremin E.
        • Tambone C.
        • Tasca A.
        A single-center study of 100 consecutive patients with localized prostate cancer treated with stereotactic body radiotherapy.
        BMC Urol. 2013; 13: 49
        • Chen L.N.
        • Suy S.
        • Uhm S.
        • et al.
        Stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience.
        Radiat Oncol. 2013; 8: 58
        • King C.R.
        • Brooks J.D.
        • Gill H.
        • Presti Jr., J.C.
        Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer.
        Int J Radiat Oncol Biol Phys. 2012; 82: 877-882
        • Loblaw A.
        • Cheung P.
        • D’Alimonte L.
        • et al.
        Prostate stereotactic ablative body radiotherapy using a standard linear accelerator: toxicity, biochemical, and pathological outcomes.
        Radiother Oncol. 2013; 107: 153-158
        • Menkarios C.
        • Vigneault E.
        • Brochet N.
        • et al.
        Toxicity report of once weekly radiation therapy for low-risk prostate adenocarcinoma: preliminary results of a phase I/II trial.
        Radiat Oncol. 2011; 6: 112
        • Koontz B.F.
        • Bossi A.
        • Cozzarini C.
        • Wiegel T.
        • D’Amico A.
        A systematic review of hypofractionation for primary management of prostate cancer.
        Eur Urol. 2015; 68: 683-691
        • Yu J.B.
        • Cramer L.D.
        • Herrin J.
        • Soulos P.R.
        • Potosky A.L.
        • Gross C.P.
        Stereotactic body radiation therapy versus intensity-modulated radiation therapy for prostate cancer: comparison of toxicity.
        J Clin Oncol. 2014; 32: 1195-1201
        • Sanda M.G.
        • Dunn R.L.
        • Michalski J.
        • et al.
        Quality of life and satisfaction with outcome among prostate-cancer survivors.
        N Engl J Med. 2008; 358: 1250-1261
        • Jereczek-Fossa B.A.
        • Santoro L.
        • Zerini D.
        • et al.
        Image guided hypofractionated radiotherapy and quality of life for localized prostate cancer: prospective longitudinal study in 337 patients.
        J Urol. 2013; 189: 2099-2103
        • Brower J.V.
        • Forman J.D.
        • Kupelian P.A.
        • et al.
        Quality of life outcomes from a dose-per-fraction escalation trial of hypofractionation in prostate cancer.
        Radiother Oncol. 2016;
        • Jean-Pierre P.
        • Stoyanova R.
        • Penedo F.
        • et al.
        Treatment-related side effects and quality of life among prostate cancer patients treated with conventional versus hypofractionated intensity mediated radiotherapy: a phase III hypofractionation trial.
        Int J Radiat Oncol Biol Phys. 2011; 81: S667
        • Wilkins A.
        • Mossop H.
        • Syndikus I.
        • et al.
        Hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate-risk localised prostate cancer: 2-year patient-reported outcomes of the randomised, non-inferiority, phase 3 CHHiP trial.
        Lancet Oncol. 2015; 16: 1605-1616
        • Evans J.R.
        • Zhao S.
        • Daignault S.
        • et al.
        Patient-reported quality of life after stereotactic body radiotherapy (SBRT), intensity modulated radiotherapy (IMRT), and brachytherapy.
        Radiother Oncol. 2015; 116: 179-184
        • Friedland J.L.
        • Freeman D.E.
        • Masterson-McGary M.E.
        • Spellberg D.M.
        Stereotactic body radiotherapy: an emerging treatment approach for localized prostate cancer.
        Technol Cancer Res Treat. 2009; 8: 387-392
        • Fuller D.
        • Mardirossian G.
        • Wong D.
        • et al.
        Prospective evaluation of stereotactic body radiation therapy for low-and intermediate-risk prostate cancer: Emulating high-dose-rate brachytherapy dose distribution.
        Int J Radiat Oncol Biol Phys. 2012; 84: S149
        • Pisansky T.M.
        • Pugh S.L.
        • Greenberg R.E.
        • et al.
        Tadalafil for prevention of erectile dysfunction after radiotherapy for prostate cancer: the Radiation Therapy Oncology Group [0831] randomized clinical trial.
        JAMA. 2014; 311: 1300-1307
        • Bhattasali O.
        • Chen L.N.
        • Woo J.
        • et al.
        Patient-reported outcomes following stereotactic body radiation therapy for clinically localized prostate cancer.
        Radiat Oncol. 2014; 9: 52
        • Meier R.
        • Kaplan I.
        • Beckman A.
        • et al.
        Patient-reported quality of life outcomes in intermediate-risk prostate cancer patients treated with stereotactic body radiation therapy.
        Int J Radiat Oncol Biol Phys. 2013; 2: S25
        • King C.R.
        • Collins S.
        • Fuller D.
        • et al.
        Health-related quality of life after stereotactic body radiation therapy for localized prostate cancer: results from a multi-institutional consortium of prospective trials.
        Int J Radiat Oncol Biol Phys. 2013; 87: 939-945
        • Hanlon A.L.
        • Watkins Bruner D.
        • Peter R.
        • Hanks G.E.
        Quality of life study in prostate cancer patients treated with three-dimensional conformal radiation therapy: comparing late bowel and bladder quality of life symptoms to that of the normal population.
        Int J Radiat Oncol Biol Phys. 2001; 49: 51-59
        • Rosen R.C.
        • Riley A.
        • Wagner G.
        • Osterloh I.H.
        • Kirkpatrick J.
        • Mishra A.
        The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction.
        Urology. 1997; 49: 822-830
        • de Vet H.C.
        • Terwee C.B.
        • Ostelo R.W.
        • Beckerman H.
        • Knol D.L.
        • Bouter L.M.
        Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change.
        Health Qual Life Outcomes. 2006; 4: 54
        • Mohler J.
        • Armstrong A.
        • Bahnson R.
        NCCN clinical practice guidelines for prostate cancer [Internet].
        2015 (Accessed on, 2015. 1(10))
        • Jean-Pierre P.
        • Stoyanova R.
        • Penedo F.
        • et al.
        Treatment-related side effects and quality of life among prostate cancer patients treated with conventional versus hypofractionated intensity mediated radiotherapy: a phase III hypofractionation trial.
        Int J Radiat Oncol Biol Phys. 2011; 81: S667
        • Barry M.J.
        • Fowler Jr., F.J.
        • O’Leary M.P.
        • et al.
        The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association.
        J Urol. 1992; 148 (discussion 1564): 1549-1557