Adding high-dose-rate (HDR) brachytherapy (BT) boost to external beam radiotherapy (EBRT) improves biochemical control but may affect patient-reported quality-of-life (QOL). We sought to determine long-term QOL outcomes for EBRT+BT versus EBRT alone.
This was a post-hoc analysis of the TROG 03.04 Randomized Androgen Deprivation and Radiotherapy (RADAR) trial. Only patients who received 74 Gy conventionally-fractionated EBRT (n=260) or 46 Gy conventionally-fractionated EBRT plus 19.5 Gy in 3 fractions HDR BT boost (n=237) were included in this analysis. The primary endpoint was patient-reported QOL measured using EORTC-QLQ-C30 and EORTC-PR25. We evaluated temporal changes in QOL scores, rates of symptom resolution, and the proportion of men who had decrements from baseline of >2x the threshold for minimal clinically important change (2xMCIC) for each domain.
At 5, 17, and 29 months post-radiotherapy, the EBRT+BT group had 2.5 times (95% confidence interval [CI]: 1.4-4.2, P<0.001), 2.9 times (95%CI: 1.7-4.9, P<0.001) and 2.6 times (95%CI: 1.4-4.6, P=0.002) greater odds of reporting 2xMCIC in urinary QOL score compared to EBRT. There were no differences beyond 29 months. EBRT+BT led to a slower rate of urinary QOL symptom score resolution up to 17 months post-radiotherapy compared to EBRT (P<0.001) but not at later intervals. In contrast, at the end of radiotherapy period and at 53 months post-radiotherapy, the EBRT+BT group had 0.65 times (95%CI: 0.44-0.96, P=0.03) and 0.51 times (95%CI: 0.32-0.79, P=0.003) the odds of reporting 2xMCIC in bowel QOL symptom scores compared to EBRT. There were no significant differences in the rate of bowel QOL score resolution. There were no significant differences in global health status or sexual activity scores between the two groups.
There were no persistent differences in patient-reported QOL measures between EBRT alone and EBRT+BT. BT boost does not appear to negatively affect long-term, patient-reported QOL.
International journal of radiation oncology, biology, physics. 2023 Oct 02 [Epub ahead of print]
Wee Loon Ong, John Nikitas, David Joseph, Allison Steigler, Jeremy Millar, Luca Valle, Michael L Steinberg, Ting Martin, Robert E Reiter, Matthew B Rettig, Nicholas G Nickols, Albert Chang, Nicholas G Zaorsky, Daniel E Spratt, Tahmineh Romero, Amar U Kishan
Alfred Health Radiation Oncology, Central Clinical School, Monash University, Melbourne VIC, Australia; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Heath Sciences Centre, University of Toronto, Toronto ON, Canada., Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA., Department of Medicine and Surgery, University of Western Australia, Perth WA, Australia., School of Medicine and Public Health, University of Newcastle, Newcastle NSW, Australia., Alfred Health Radiation Oncology, Central Clinical School, Monash University, Melbourne VIC, Australia., Department of Urology, University of California, Los Angeles, Los Angeles, CA., Division of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of Hematology and Oncology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA., Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA; Department of Radiation Oncology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA., Department of Radiation Oncology, University Hospitals Seidman Cancer Centre, Cleveland Medical Centre, Cleveland OH., Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles CA. Electronic address: ., Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA; Department of Urology, University of California, Los Angeles, Los Angeles, CA. Electronic address: .