A comparative study of patient-reported outcomes after contemporary radiation techniques for prostate cancer. (June 2022)

• Record Type: Journal Article
• Authors: Helou, Joelle; Morton, Gerard; Kiss, Alex; Mittmann, Nicole; Ravi, Ananth; Chung, Hans; Davidson, Melanie; Cheung, Patrick; Bezjak, Andrea; Loblaw, Andrew
• Is Part Of: Radiotherapy and oncology. Volume 171(2022)
• Page Start: 164
• Page End: 172
• Publication Date: 2022-06
• Subjects: Prostate cancer -- Patient-reported outcomes -- Quality of life -- Stereotactic body radiotherapy -- High dose-rate brachytherapy; 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.2022.04.025
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Health-related quality of life (HRQoL) is important for men with prostate cancer. HRQoL loss was compared at 1 year with 3 different ablative radiotherapy regimens. SABR and HDR monotherapy had better urinary and sexual HRQoL compared to HDR boost. HDR monotherapy had better bowel HRQoL compared to SABR and HDR boost. Abstract: Purpose: We aim to compare health-related quality of life (HRQoL) deterioration at 12 months in low-and intermediate-risk prostate cancer (PCa) patients treated with stereotactic ablative radiotherapy (SABR), high dose-rate brachytherapy (HDR) monotherapy and HDR boost. Material and methods: Patients treated as part of 7 prospective clinical trials were included. All patients had low-or intermediate-risk PCa. Three strategies were considered: SABR, HDR monotherapy and HDR boost. HRQoL was prospectively measured at baseline and 12 months in all trials, using the Expanded Prostate Index Composite (EPIC). A minimally important difference (MID) was defined as a deterioration of HRQoL scores at 12 months compared to baseline ≥0.5 standard deviation of baseline score. Univariate and multivariable logistic regression using generalized estimating equations were used to compare the proportion of patients having MID between groups. A set of sensitivity analyses was conducted. Results: 648 patients were included: 288, 173 and 187 respectively in the SABR, HDR monotherapy and HDR boost group. On univariate and multivariable analyses, SABR and HDR monotherapy compared to HDR boost, were associated with less deterioration in the urinary (38%, 40% vs. 55%; OR:0.543, 95%CI:0.320–0.922, p = 0.024; OR:0.468, 95%CI:0.432–0.507, p < 0.001) and sexual domains (38%, 42% vs. 47%; OR:0.762, 95%CI:0.645–0.900, p = 0.001; OR: 0.786, 95%CI:0.650–0.949, p = 0.012). These findings were robust to a variety of sensitivity analyses. Conclusion: Recent monotherapeutic approaches for low- and intermediate-risk PCa are associated with the preservation of patients HRQoL. Ultimately, the questions of efficacy, toxicity, and HRQoL will be best answered by a randomized clinical trial.