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Title: Health-Related Quality of Life After Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Prostate Cancer

Abstract

Purpose: To investigate the change in health-related quality of life for men after high-dose-rate brachytherapy and external beam radiotherapy for prostate cancer and the factors associated with this change. Methods and Materials: Eligible patients had clinically localized intermediate-risk prostate cancer. The patients received high-dose-rate brachytherapy as a single 15-Gy implant, followed by external beam radiotherapy to 37.5 Gy in 15 fractions. The patients were monitored prospectively for toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and health-related quality of life (Expanded Prostate Cancer Index Composite [EPIC]). The proportion of patients developing a clinically significant difference in the EPIC domain score (minimally important difference of >0.5 standard deviation) was determined and correlated with the baseline clinical and dosimetric factors. The study accrued 125 patients, with a median follow-up of 24 months. Results: By 24 months, 23% had Grade 2 urinary toxicity and only 5% had Grade 2 bowel toxicity, with no Grade 3 toxicity. The proportion of patients reporting a significant decrease in EPIC urinary, bowel, sexual, and hormonal domain scores was 53%, 51%, 45%, and 40% at 12 months and 57%, 65%, 51%, and 30% at 24 months, respectively. The proportion with a >1 standard deviation decrease in themore » EPIC urinary, bowel, sexual, and hormonal domain scores was 38%, 36%, 24%, and 20% at 12 months and 46%, 48%, 19%, and 8% at 24 months, respectively. On multivariate analysis, the dose to 10% of the urethra was associated with a decreasing EPIC urinary domain score (p = .0089) and, less strongly (p = .0312) with a decreasing hormonal domain score. No association was found between the prostate volume, bladder dose, or high-dose volume and urinary health-related quality of life. A high baseline International Index of Erectile Function score was associated (p = .0019) with a decreasing sexual domain score. The optimal maximal dose to 10% of the urethra cutpoint for urinary health-related quality of life was 120% of the prescription dose. Conclusion: EPIC was a more sensitive tool for detecting the effects on function and bother than were the generic toxicity scales. The urethral dose had the strongest association with a deteriorating urinary quality of life.« less

Authors:
 [1]; ;  [1];  [2];  [3]; ; ;  [4];  [1];  [3]; ;  [1]
  1. Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON (Canada)
  2. Premion, Wesley Medical Centre, Brisbane, Queensland (Australia)
  3. Department of Medical Physics, Odette Cancer Centre, University of Toronto, Toronto, ON (Canada)
  4. Department of Clinical Trials and Epidemiology, Odette Cancer Centre, University of Toronto, Toronto, ON (Canada)
Publication Date:
OSTI Identifier:
21587662
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 80; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2010.04.046; PII: S0360-3016(10)00639-5; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BLADDER; BRACHYTHERAPY; DOSE RATES; DOSIMETRY; HAZARDS; HORMONES; MULTIVARIATE ANALYSIS; NEOPLASMS; PROSTATE; RADIATION DOSES; RADIATION SOURCE IMPLANTS; STANDARD OF LIVING; TOXICITY; BODY; DISEASES; DOSES; GLANDS; IMPLANTS; MALE GENITALS; MATHEMATICS; MEDICINE; NUCLEAR MEDICINE; ORGANS; RADIATION SOURCES; RADIOLOGY; RADIOTHERAPY; STATISTICS; THERAPY; URINARY TRACT

Citation Formats

Morton, Gerard C., E-mail: gerard.morton@sunnybrook.ca, Loblaw, D. Andrew, Chung, Hans, Tsang, Gail, Sankreacha, Raxa, Deabreu, Andrea, Zhang Liying, Mamedov, Alexandre, Cheung, Patrick, Batchelar, Deidre, Danjoux, Cyril, and Szumacher, Ewa. Health-Related Quality of Life After Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Prostate Cancer. United States: N. p., 2011. Web. doi:10.1016/j.ijrobp.2010.04.046.
Morton, Gerard C., E-mail: gerard.morton@sunnybrook.ca, Loblaw, D. Andrew, Chung, Hans, Tsang, Gail, Sankreacha, Raxa, Deabreu, Andrea, Zhang Liying, Mamedov, Alexandre, Cheung, Patrick, Batchelar, Deidre, Danjoux, Cyril, & Szumacher, Ewa. Health-Related Quality of Life After Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Prostate Cancer. United States. doi:10.1016/j.ijrobp.2010.04.046.
Morton, Gerard C., E-mail: gerard.morton@sunnybrook.ca, Loblaw, D. Andrew, Chung, Hans, Tsang, Gail, Sankreacha, Raxa, Deabreu, Andrea, Zhang Liying, Mamedov, Alexandre, Cheung, Patrick, Batchelar, Deidre, Danjoux, Cyril, and Szumacher, Ewa. Mon . "Health-Related Quality of Life After Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Prostate Cancer". United States. doi:10.1016/j.ijrobp.2010.04.046.
@article{osti_21587662,
title = {Health-Related Quality of Life After Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Prostate Cancer},
author = {Morton, Gerard C., E-mail: gerard.morton@sunnybrook.ca and Loblaw, D. Andrew and Chung, Hans and Tsang, Gail and Sankreacha, Raxa and Deabreu, Andrea and Zhang Liying and Mamedov, Alexandre and Cheung, Patrick and Batchelar, Deidre and Danjoux, Cyril and Szumacher, Ewa},
abstractNote = {Purpose: To investigate the change in health-related quality of life for men after high-dose-rate brachytherapy and external beam radiotherapy for prostate cancer and the factors associated with this change. Methods and Materials: Eligible patients had clinically localized intermediate-risk prostate cancer. The patients received high-dose-rate brachytherapy as a single 15-Gy implant, followed by external beam radiotherapy to 37.5 Gy in 15 fractions. The patients were monitored prospectively for toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and health-related quality of life (Expanded Prostate Cancer Index Composite [EPIC]). The proportion of patients developing a clinically significant difference in the EPIC domain score (minimally important difference of >0.5 standard deviation) was determined and correlated with the baseline clinical and dosimetric factors. The study accrued 125 patients, with a median follow-up of 24 months. Results: By 24 months, 23% had Grade 2 urinary toxicity and only 5% had Grade 2 bowel toxicity, with no Grade 3 toxicity. The proportion of patients reporting a significant decrease in EPIC urinary, bowel, sexual, and hormonal domain scores was 53%, 51%, 45%, and 40% at 12 months and 57%, 65%, 51%, and 30% at 24 months, respectively. The proportion with a >1 standard deviation decrease in the EPIC urinary, bowel, sexual, and hormonal domain scores was 38%, 36%, 24%, and 20% at 12 months and 46%, 48%, 19%, and 8% at 24 months, respectively. On multivariate analysis, the dose to 10% of the urethra was associated with a decreasing EPIC urinary domain score (p = .0089) and, less strongly (p = .0312) with a decreasing hormonal domain score. No association was found between the prostate volume, bladder dose, or high-dose volume and urinary health-related quality of life. A high baseline International Index of Erectile Function score was associated (p = .0019) with a decreasing sexual domain score. The optimal maximal dose to 10% of the urethra cutpoint for urinary health-related quality of life was 120% of the prescription dose. Conclusion: EPIC was a more sensitive tool for detecting the effects on function and bother than were the generic toxicity scales. The urethral dose had the strongest association with a deteriorating urinary quality of life.},
doi = {10.1016/j.ijrobp.2010.04.046},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 5,
volume = 80,
place = {United States},
year = {2011},
month = {8}
}