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Evans JR, Zhao S, Daignault S, Sanda MG, Michalski J, Sandler HM, Kuban DA, Ciezki J, Kaplan ID, Zietman AL, Hembroff L, Feng FY, Suy S, Skolarus TA, McLaughlin PW, Wei JT, Dunn RL, Finkelstein SE, Mantz CA, Collins SP, Hamstra DA, PROSTQA Study Consortium. Patient-reported quality of life after stereotactic body radiotherapy (SBRT), intensity modulated radiotherapy (IMRT), and brachytherapy. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2015 Aug 11.
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.