Joseph R Evans1, Shuang Zhao1, Stephanie Daignault2, Martin G Sanda3, Jeff Michalski4, Howard M Sandler5, Deborah A Kuban6, Jay Ciezki7, Irving D Kaplan8, Anthony L Zietman9, Larry Hembroff10, Felix Y Feng1, Simeng Suy11, Ted A Skolarus12, Patrick W McLaughlin1, John T Wei13, Rodney L Dunn13, Steven E Finkelstein14, Constantine A Mantz14, Sean P Collins11, Daniel A Hamstra15. 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. Electronic address: dhamm@umich.edu.
Abstract
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 -13.3 points 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 (-6.8 points, 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 (+6.7 points, 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.
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 -13.3 points 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 (-6.8 points, 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 (+6.7 points, 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.
Authors: Himanshu R Lukka; Stephanie L Pugh; Deborah W Bruner; Jean-Paul Bahary; Colleen A F Lawton; Jason A Efstathiou; Rajat J Kudchadker; Lee E Ponsky; Samantha A Seaward; Ian S Dayes; Darindra D Gopaul; Jeff M Michalski; Guila Delouya; Irving D Kaplan; Eric M Horwitz; Mack Roach; Wayne H Pinover; David C Beyer; John O Amanie; Howard M Sandler; Lisa A Kachnic Journal: Int J Radiat Oncol Biol Phys Date: 2018-06-18 Impact factor: 7.038
Authors: Michael C Repka; Shan Guleria; Robyn A Cyr; Thomas M Yung; Harsha Koneru; Leonard N Chen; Siyuan Lei; Brian T Collins; Pranay Krishnan; Simeng Suy; Anatoly Dritschilo; John Lynch; Sean P Collins Journal: Front Oncol Date: 2016-05-18 Impact factor: 6.244
Authors: Dominic H Moon; Ram S Basak; Deborah S Usinger; Gregg A Dickerson; David E Morris; Mark Perman; Maili Lim; Turner Wibbelsman; Jerry Chang; Zachary Crawford; James R Broughman; Paul A Godley; Ronald C Chen Journal: Eur Urol Date: 2019-03-08 Impact factor: 20.096