Patient-reported functional outcomes following external beam radiation therapy for prostate cancer with and without a high-dose rate brachytherapy boost: A national population-based study. (February 2021)

• Record Type: Journal Article
• Authors: Parry, Matthew G.; Nossiter, Julie; Cowling, Thomas E.; Sujenthiran, Arunan; Berry, Brendan; Cathcart, Paul; Clarke, Noel W.; Payne, Heather; van der Meulen, Jan; Aggarwal, Ajay
• Is Part Of: Radiotherapy and oncology. Volume 155(2021)
• Page Start: 48
• Page End: 55
• Publication Date: 2021-02
• Subjects: Prostate cancer -- Brachytherapy boost -- High-dose-rate -- External beam radiation therapy -- Patient-reported outcomes; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2020.10.019
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: A high-dose rate brachytherapy boost (HDR-BB) can reduce biochemical recurrence. Functional outcomes after HDR-BB are limited. This study shows that functional outcomes after HDR-BB are encouraging. Urinary irritation/obstruction is worse after HDR-BB compared to radiotherapy only. Whether this difference in function is clinically important remains uncertain. Abstract: Background and purpose: Little is known about the functional outcomes and health-related quality of life (HRQoL) following external beam radiation therapy (EBRT) combined with a high-dose rate brachytherapy boost (EBRT-BB) for the treatment of prostate cancer. We aimed to compare patient-reported outcomes of EBRT to those of EBRT-BB. Methods and materials: Patients diagnosed with intermediate-risk, high-risk or locally advanced prostate cancer (April 2014 to September 2016), who received EBRT in the English National Health Service within 18 months of diagnosis and responded to a national patient questionnaire, were identified from the National Prostate Cancer Audit. Adjusted linear regression was used to estimate differences in functional EPIC-26 domains and HRQoL (EQ-5D-5L) between treatment groups. Non-inferiority of EBRT-BB was determined if the lower 95% confidence limit did not exceed the established minimal clinically important difference (MCID). Results: Of the 13, 259 included men, 12, 503 (94.3%) received EBRT and 756 (5.7%) received EBRT-BB. EBRT-BB was non-inferior compared to EBRT for the urinary incontinence, sexual, bowel and hormonal EPIC-26 domains. EBRT-BB resulted in significantly worse urinary irritation/obstruction scores than EBRT (−6.1; 95% CI: −8.8 to −3.4) but uncertainty remains as to whether this difference is clinically important (corresponding MCID of 5). Conclusions: There is no evidence to suggest that EBRT-BB results in any clinically important detriment in functional outcomes or HRQoL compared to men receiving EBRT only. Whilst statistically significantly worse urinary irritation/obstruction outcomes were reported in the EBRT-BB cohort, the threshold for a clinically significant difference was not exceeded and further research is required for confirmation.