Quality of life outcomes from a dose-per-fraction escalation trial of hypofractionation in prostate cancer

Abstract

Objective: This multi-institutional phase I/II trial explored patient-assessed tolerance of increasingly hypofractionated (HPFX) radiation for low/intermediate risk prostate cancer.

Methods: 347 patients enrolled from 2002 to 2010. Three increasing dose-per-fraction schedules of 64.7 Gy/22 fx, 58.08 Gy/16 fx and 51.6 Gy/12 fx were each designed to yield equivalent predicted late toxicity. Three quality of life (QoL) surveys were administered prior to treatment and annually upto 3 years.

Results: Bowel QoL data at 3years revealed no significant difference among regimens (p=0.469). Bowel QoL for all regimens declined transiently, largely recovering by three years, with only the 22 fraction decrement reaching significance. Bladder outcomes at 3 years were comparable (p=0.343) although, for all patients combined, a significant decline was observed from the baseline (p=0.008). Spitzer quality of life data revealed similarly excellent, 3-year means (p=0.188). International erectile function data also revealed no significant differences at 3 years although all measures except intercourse satisfaction worsened post-treatment.

Conclusions: Three-year QoL changes for bowel, bladder and SQLI were modest and similar for 3 HPFX regimens spanning 2.94-4.3 Gy per fraction. These favorable patient-scored outcomes demonstrate the safety and tolerability of such regimens and may be leveraged to support further implementation of mild to moderately hypofractionated radiotherapy in the setting of low and intermediate-risk prostate cancer.

Keywords: Hypofractionation; Prostate; Quality of life; SBRT.

Conflict of interest statement

Conflicts of Interest Notification: Conflict of Interest: none

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

A, B: QoL metrics from baseline to year three. A. Bowel and B. Bladder * Indicates statistically significant change from baseline. C, D: Physician scored toxicities. C. Bowel and D. Bladder

Figure 2

Spitzer Quality of Life change from baseline to year three