Robert T Dess1, William C Jackson1, Simeng Suy2, Payal D Soni1, Jae Y Lee1, Ahmed E Abugharib3, Zachary S Zumsteg4, Felix Y Feng5, Daniel A Hamstra6, Sean P Collins2, Daniel E Spratt1. 1. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. 2. Department of Radiation Oncology, Georgetown University, Washington, District of Columbia. 3. Department of Oncology, Sohag University, Sohag, Egypt. 4. Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California. 5. Department of Radiation Oncology, University of California-San Francisco, San Francisco, California. 6. Department of Radiation Oncology, Texas Oncology, Irving, Texas.
Abstract
BACKGROUND: Stereotactic body radiation therapy (SBRT) for localized prostate cancer involves high-dose-per-fraction radiation treatments. Its use is increasing, but concerns remain about treatment-related toxicity. The authors assessed the incidence and predictors of a global decline in health-related quality of life (HRQOL) after prostate SBRT. METHODS: From 2008 to 2014, 713 consecutive men with localized prostate cancer received treatment with SBRT according to a prospective institutional protocol. Expanded Prostate Cancer Index Composite (EPIC-26) HRQOL data were collected at baseline and longitudinally for 5 years. EPIC-26 is comprised of 5 domains. The primary endpoint was defined as a decline exceeding the clinically detectable threshold in ≥4 EPIC-26 domains, termed multidomain decline. RESULTS: The median age was 69 years, 46% of patients had unfavorable intermediate-risk or high-risk disease, and 20% received androgen-deprivation therapy. During 1 to 3 months and 6 to 60 months after SBRT, 8% to 15% and 10% to 11% of patients had multidomain declines, respectively. On multivariable analysis, lower baseline bowel HRQOL (odds ratio, 1.8; 95% confidence interval, 1.2-2.7; P < .01) and baseline depression (odds ratio, 5.7; 95% confidence interval, 1.3-24.3; P = .02) independently predicted for multidomain decline. Only 3% to 4% of patients had long-term multidomain declines exceeding twice the clinical threshold, and 30% of such declines appeared to be related to prostate cancer treatment or progression of disease. CONCLUSIONS: Prostate SBRT has minimal long-term impact on multidomain decline, and the majority of more significant multidomain declines appear to be unrelated to treatment. This emphasizes the importance of focusing not only on the side effects of prostate cancer treatment but also on other comorbid illnesses that contribute to overall HRQOL. Cancer 2017;123:1635-1642.
BACKGROUND: Stereotactic body radiation therapy (SBRT) for localized prostate cancer involves high-dose-per-fraction radiation treatments. Its use is increasing, but concerns remain about treatment-related toxicity. The authors assessed the incidence and predictors of a global decline in health-related quality of life (HRQOL) after prostate SBRT. METHODS: From 2008 to 2014, 713 consecutive men with localized prostate cancer received treatment with SBRT according to a prospective institutional protocol. Expanded Prostate Cancer Index Composite (EPIC-26) HRQOL data were collected at baseline and longitudinally for 5 years. EPIC-26 is comprised of 5 domains. The primary endpoint was defined as a decline exceeding the clinically detectable threshold in ≥4 EPIC-26 domains, termed multidomain decline. RESULTS: The median age was 69 years, 46% of patients had unfavorable intermediate-risk or high-risk disease, and 20% received androgen-deprivation therapy. During 1 to 3 months and 6 to 60 months after SBRT, 8% to 15% and 10% to 11% of patients had multidomain declines, respectively. On multivariable analysis, lower baseline bowel HRQOL (odds ratio, 1.8; 95% confidence interval, 1.2-2.7; P < .01) and baseline depression (odds ratio, 5.7; 95% confidence interval, 1.3-24.3; P = .02) independently predicted for multidomain decline. Only 3% to 4% of patients had long-term multidomain declines exceeding twice the clinical threshold, and 30% of such declines appeared to be related to prostate cancer treatment or progression of disease. CONCLUSIONS: Prostate SBRT has minimal long-term impact on multidomain decline, and the majority of more significant multidomain declines appear to be unrelated to treatment. This emphasizes the importance of focusing not only on the side effects of prostate cancer treatment but also on other comorbid illnesses that contribute to overall HRQOL. Cancer 2017;123:1635-1642.
Keywords:
Expanded Prostate Cancer Index (EPIC); Patient-reported outcomes (PRO); health-related quality of life (HRQOL); prostate cancer; stereotactic body radiation (SBRT)
Authors: Scott C Morgan; Karen Hoffman; D Andrew Loblaw; Mark K Buyyounouski; Caroline Patton; Daniel Barocas; Soren Bentzen; Michael Chang; Jason Efstathiou; Patrick Greany; Per Halvorsen; Bridget F Koontz; Colleen Lawton; C Marc Leyrer; Daniel Lin; Michael Ray; Howard Sandler Journal: J Clin Oncol Date: 2018-10-11 Impact factor: 44.544
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: Amy Y Zhang; Stephen Ganocy; Alex Z Fu; Denise Kresevic; Lee Ponsky; Gerald Strauss; Donald R Bodner; Hui Zhu Journal: Support Care Cancer Date: 2019-03-22 Impact factor: 3.603