Long-term patient-reported outcomes indicate that for some men with localised prostate cancer, hypofractionated (HRT) intensity-modulated radiation therapy (IMRT) may be a reasonable treatment option and result in similar quality of life outcomes, when compared to conventional radiation therapy (CRT), according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 57th Annual Meeting.

Men diagnosed with prostate cancer have multiple treatment options.

When determining which treatment option(s) will be best for each patient, careful consideration must be given to treatment-related side effects and long-term toxicity, because men diagnosed with prostate cancer typically often have a long life expectancy.

Although the body of literature on long-term quality of life outcomes in patients treated for prostate cancer is growing, there had previously been no long- term prospective data on quality of life outcomes following HRT, which is given at a higher dose over a shorter period of time than CRT (which is typically given daily on a Monday through Friday schedule, over approximately eight weeks at 2 Gy per fraction.)

This prospective, phase III study was conducted from 2002 to 2006, 303 men with low- to high- risk prostate cancer received randomised treatment, consisting of either CRT at 76 Gy in 38 fractions at 2.0 Gy per fraction, or HRT at 70.2 Gy in 26 fractions at 2.7 Gy per fraction.

Patient-reported outcomes (PROs) were gathered at a median follow-up of 69 months and compared using the Expanded Prostate Cancer Index Composite (EPIC) and International Prostate Symptom Score (IPSS) questionnaires; PRO scores were reported as mean at each time point.

Changes from baseline (defined as score <1 month prior to initiation of RT) were compared between treatment arms.

Generalised estimating equation models were used to assess the effect of treatment over time.

Results of this study found that PROs were not statistically different with long-term follow-up in patients receiving CRT or HRT for localised prostate cancer.

Although EPIC scores indicated an initial decrease in quality of life scores in both groups, it subsequently improved.

There were no apparent differences in long-term quality of life outcomes in terms of bowel, sexual, hormonal, or general health status when comparing the two arms.

Patients receiving HRT initially appeared to have worse urinary incontinence three to four years after treatment, although this subsequently resolved.

As with any treatment modality, patient selection is a key factor to deliver effective care.

When examining both treatment groups, their baseline quality of life was the strongest predictor of quality of life at 48 months.

Patients who have poor baseline urinary functional status should be counselled regarding the potential impact that HRT may have on their long-term quality of life.

“Our results, which demonstrate that delivery of hypofractionated radiation is feasible in a select group of individuals, are not surprising,” said Talha Shaikh, MD, lead author of the study and resident in the department of radiation oncology at Fox Chase Cancer Center.

“Although physicians have often worried about delivering HRT to the prostate, advanced radiation techniques have made delivery of high dose conformal radiation with minimal toxicity increasingly attainable. In this era of Health Care Reform, reducing treatment time and cost while maintaining efficacy is intriguing.”

Source: ASTRO