Patient-reported quality of life after stereotactic body radiotherapy (SBRT), intensity modulated radiotherapy (IMRT), and brachytherapy

BACKGROUND AND PURPOSE - Stereotactic body radiotherapy (SBRT) is being used for prostate cancer, but concerns persist about toxicity compared to other radiotherapy options.

MATERIALS AND METHODS - We conducted a multi-institutional pooled cohort analysis of patient-reported quality of life (QOL) [EPIC-26] before and after intensity-modulated radiotherapy (IMRT), brachytherapy, or SBRT for localized prostate cancer. Data were analyzed by mean domain score, minimal clinically detectable difference (MCD) in domain score, and multivariate analyses to determine factors associated with domain scores at 2-years.

RESULTS - Data were analyzed from 803 patients at baseline and 645 at 2-years. Mean declines at 2-years across all patients were -1.9, -4.8, -4.9, and -13.3points for urinary obstructive, urinary incontinence, bowel, and sexual symptom domains, respectively, corresponding to MCD in 29%, 20%, and 28% of patients. On multivariate analysis (vs. IMRT), brachytherapy had worse urinary irritation at 2-years (-6.8points, p<0.0001) but no differences in other domains (p>0.15). QOL after SBRT was similar for urinary (p>0.5) and sexual domains (p=0.57), but was associated with better bowel score (+6.7points, p<0.0002).

CONCLUSIONS - QOL 2-years after brachytherapy, IMRT, or SBRT is very good and largely similar, with small differences in urinary and bowel QOL that are likely minimized by modern techniques.

Radiother Oncol. 2015 Aug 11. pii: S0167-8140(15)00368-0. doi: 10.1016/j.radonc.2015.07.016. [Epub ahead of print]

Evans JR1, Zhao S1, Daignault S2, Sanda MG3, Michalski J4, Sandler HM5, Kuban DA6, Ciezki J7, Kaplan ID8, Zietman AL9, Hembroff L10, Feng FY1, Suy S11, Skolarus TA12, McLaughlin PW1, Wei JT13, Dunn RL13, Finkelstein SE14, Mantz CA14, Collins SP11, Hamstra DA15; PROSTQA Study Consortium.

1 Department of Radiation Oncology, University of Michigan, Ann Arbor, United States.
2 Department of Biostatistics, University of Michigan, United States.
3 Department of Urology, Emory University, Atlanta, United States.
4 Department of Radiation Oncology, Washington University Medical Center, St. Louis, United States.
5 Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, United States.
6 Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, United States.
7 Department of Radiation Oncology, Cleveland Clinic, United States.
8 Beth Israel Deaconess Medical Center, Boston, United States.
9 Department of Radiation Oncology, Massachusetts General Hospital, Boston, United States.
10 Michigan State University, East Lansing, United States.
11 Georgetown University, Washington, United States.
12 Department of Urology, University of Michigan, United States; HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States.
13 Department of Urology, University of Michigan, United States.
14 21st Century Oncology, Ft Meyers, United States.
15 Department of Radiation Oncology, University of Michigan, Ann Arbor, United States.