Pam Harrison

October 26, 2015

Patient-reported outcomes following treatment of localized prostate cancer with higher doses of radiation given over a shorter period were not significantly different from outcomes following conventional radiation therapy, long-term follow-up of a phase 3 randomized study suggests.

The study was presented during the American Society for Radiation Oncology (ASTRO) 57th Annual Meeting.

"Physicians have often worried about delivering hypofractionated radiation therapy to the prostate, [but] advanced radiation techniques have made delivery of high-dose conformal radiation with minimal toxicity increasingly attainable," Talha Shaikh, MD, resident, Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, said in a statement.

"In this era of healthcare reform, reducing treatment time and cost while maintaining efficacy is intriguing."

Between 2002 and 2006, 303 men with low- to high-risk localized prostate cancer were randomly assigned to receive either intensity-modulated radiation therapy (IMRT) delivered in a dose of 76 Gy in 38 fractions at 2.0 Gy per fraction or IMRT on a hypofractionated schedule of 70.2 Gy in 26 fractions at 2.7 Gy per fraction.

Final results were published in 2013 and demonstrated no significant difference in biochemical outcomes between subgroups.

For the current analysis, Dr Shaikh and colleagues assessed the long-term quality-of-life outcomes between the two groups.

Patients completed quality-of-life self-assessment forms prior to receiving radiation and at multiple time points during a period of up to 60 months. Patient-reported outcomes were compared using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire, the International Prostate Symptom Score, and the EQ-5D score.

Changes from baseline — defined as the score less than 1 month prior to initiation of either radiation protocol ― were compared between treatment arms.

At a median follow-up of 69 months, no significant difference between the two arms was observed in either clinical or treatment-related characteristics.

No significant differences in mean changes in EPIC scores in bowel, sexual, hormonal, or urinary irritative/obstructive domains were seen between the two treatment groups.

However, patients in the hypofractionated radiation arm exhibited greater decreases in EPIC urinary incontinence compared with patients in the conventional radiation arm at 3 years (P = .03), although this was no longer significantly different at 5-year follow-up.

There were also no significant differences in overall IPSS or quality-of-life scores between the two treatment cohorts, although there was a trend toward a worse IPSS score at 2 and 3 years in the hypofractionated group, which again improved with further follow-up.

Table. Patient-Reported EPIC Domain Scores

  Conventional RT Hypofractionated RT
Bowel (3 years/5 years) -2.96/-4.41 -3.24/-5.33
Sexual (3 years/5 years) -17.79/-14.23 -13.59/-19.80
Hormone (3 years/5 years) -3.21/-0.41 -3.33/-2.51
Urinary incontinence (3 years/5 years) -1.26/-3.73 -7.24/-9.03
Urinary irritation/obstruction (3 years/5 years) 0.04/-2.13 -3.27/-1.35


"Patients with poor baseline genitourinary function may have worse quality-of-life outcomes with hypofractionated radiation vs conventionally fractionated radiation," Dr Shaikh said.

"But in general, hypofractionated and conventionally fractionated radiation result in similar long-term quality-of-life outcomes."

Dr Shaikh has disclosed no relevant financial relationships.

American Society for Radiation Oncology (ASTRO) 57th Annual Meeting: Abstract 77. Presented October 19, 2015.


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