Abstract
The optimal prostate stereotactic body radiation therapy (SBRT) dose-fractionation scheme is controversial. This study compares long-term quality of life (QOL) from two prospective trials of prostate SBRT to investigate the effect of increasing dose (NCT01578902 and NCT01146340). Patients with localized prostate cancer received SBRT 35 or 40 Gy delivered in five fractions, once per week. QOL was measured using the Expanded Prostate Cancer Index Composite at baseline and every 6 months. Fisher's exact test and generalized estimating equations were used to analyze proportions of patients with clinically significant change and longitudinal changes in QOL. One hundred fourteen patients were included, 84 treated with 35 Gy and 30 treated with 40 Gy. Median QOL follow-up was 56 months [interquartile range (IQR) 46-60] and 38 months (IQR 32-42), respectively. The proportion of patients reporting clinically significant declines in average urinary, bowel, and sexual scores were not significantly different between dose levels, and were 20.5 vs. 24.1% (p = 0.60), 26.8 vs. 41.4% (p = 0.16), and 42.9 vs. 38.5% (p = 0.82), respectively. Similarly, longitudinal analysis did not identify significant differences in QOL between treatment groups. Dose-escalated prostate SBRT from 35 to 40 Gy in five fractions was not associated with significant decline in long-term QOL.
Highlights
There has been significant interest in stereotactic body radiation therapy (SBRT) for prostate cancer, given the potential for increased tumor control [1], patient convenience, and lower treatment costs [2]
Owing to different study eligibility criteria, there was a greater proportion of patients with Gleason 6 adenocarcinoma (100 vs. 60%, p < 0.0001) and Prostate Cancer Risk Stratification (ProCaRS) [12] low-risk disease (100 vs. 60%, p < 0.0001) in study 1
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Summary
There has been significant interest in stereotactic body radiation therapy (SBRT) for prostate cancer, given the potential for increased tumor control [1], patient convenience, and lower treatment costs [2]. The optimal dose and fractionation remain controversial, with total doses ranging from 33.5 to 50 Gy delivered in five fractions [3,4,5]. No randomized studies have been conducted to evaluate the impact of dose-escalated prostate SBRT. In the only prospective dose-escalation SBRT study to date, groups of 15 patients received 45, 47.5, and 50 Gy in five fractions [5]. Grade 3+ toxicities were limited to one patient treated with 47.5 Gy and two patients who received 50 Gy. Bowel quality of life (QOL) was worse for patients on the 47.5 Gy arm, but no differences were found in urinary QOL
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