BACKGROUND: Treatment-related toxicity and quality of life (QoL) considerations are important when counseling patients with localized prostate cancer (PCa).
OBJECTIVE: To determine the incidence and longitudinal pattern of late genitourinary (GU) toxicity and QoL after high-dose, intensity-modulated radiotherapy (IMRT).
DESIGN, SETTING, AND PARTICIPANTS: A total of 268 patients with localized PCa were treated between June 2004 and December 2008 at a tertiary referral center. Median follow-up was 5 yr (range: 3-7.7 yr).
INTERVENTION: Patients underwent IMRT to a total dose of 86.4Gy; 50% of patients underwent neoadjuvant and concurrent androgen-deprivation therapy.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Patients were evaluated with the prospectively obtained International Prostate Symptom Score (IPSS) questionnaire. GU toxicity was also scored using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.0; toxicity events were defined as increase over baseline. Differences in increases in IPSS sums and QoL index between baseline IPSS sum and QoL index groups were analyzed using the Kruskal-Wallis and Mann-Whitney tests. Univariate and multivariate Cox regression models were applied.
RESULTS AND LIMITATIONS: The overall median IPSS sum increase during follow-up was 3 and was less pronounced among patients with severe baseline symptoms compared with those with mild baseline symptoms (median increase: 0 vs 4; p< 0.0001). Overall QoL index was unchanged after IMRT but appeared to improve in patients with dissatisfied baseline QoL compared with satisfied baseline QoL (p< 0.0001). Fifty-five (20%) and 2 (1%) patients developed grade 2 and 3 late GU toxicities, respectively; however, in 28 of 57 patients (49%), toxicity resolved during follow-up. Even though the IPSS data were prospectively obtained, most patients were not treated within a prospective protocol.
CONCLUSIONS: Late GU toxicity after high-dose IMRT was mild; severe, late GU toxicity was rare. Changes in IPSS sum and QoL index were dependent on the baseline GU function, which might be useful for future patient counseling.
Written by:
Ghadjar P, Jackson A, Spratt DE, Oh JH, Munck Af Rosenschöld P, Kollmeier M, Yorke E, Hunt M, Deasy JO, Zelefsky MJ. Are you the author?
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Reference: Eur Urol. 2013 Feb 14. pii: S0302-2838(13)00113-9.
doi: 10.1016/j.eururo.2013.02.001
PubMed Abstract
PMID: 23522772
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