Health-related quality of life after ultrafocal salvage high-dose-rate brachytherapy for radiorecurrent prostate cancer: reporting the patient’s perspective

Marieke Van Son,Evelyn Monninkhof,Max Peters,Jan Lagendijk,Jochem Van Der Voort Van Zyp

doi:10.1016/j.ctro.2020.10.002

Abstract

PurposeFor patients with a localized prostate cancer recurrence after radiotherapy, focal salvage treatment offers a less toxic alternative to whole-gland treatments, with the potential of preserving health-related quality of life (HR-QoL). With a focus on the patient’s perspective of treatment, this study aims to describe HR-QoL after ultrafocal salvage high-dose-rate brachytherapy (HDR-BT), and to explore predictive factors affecting HR-QoL. Material and methodsWe included 100 patients treated with ultrafocal salvage HDR-BT. Prostate cancer-related HR-QoL was assessed by the EORTC QLQ-PR25 questionnaire. Domains were urinary symptoms, bowel symptoms and sexual activity/functioning. For each domain, a mixed effects model was made to estimate HR-QoL trends over time. For domains showing clinically relevant change (≥10 points difference), the mixed effects model was used to explore potential predictors (age, baseline HR-QoL score, T-stage, tumor location, CTV size, dose to organs at risk and history of ADT). ResultsMedian follow-up was 20 months (IQR 13–30). Mean questionnaire response rate was 86% (range 72–100%). Median baseline scores were 12 (urinary), 0 (bowel) and 67/50 (sexual activity/functioning). Urinary symptoms and sexual functioning showed clinically relevant deterioration over time (maximum difference of 11 and 12 points, respectively). Worse baseline score and higher administered dose to the urethra (≥16 Gy) were predictive of increased urinary symptoms (p < 0.01 and p = 0.03). Better baseline score was predictive of better sexual functioning (p < 0.01). ConclusionUltrafocal salvage HDR-BT has negligible impact on bowel symptoms but does affect urinary symptoms and sexual functioning. Lower impact is predicted for patients with favorable urinary and sexual function at baseline. Urethral dose constraints should be closely monitored.

Highlights

As a result of treatment innovations and increased cancer survival, more attention is directed towards patient-reported outcomes such as health-related Quality of Life (HR-QoL)
Salvage prostatectomy and HIFU are associated with higher urinary incontinence rates (40–50%) than salvage cryotherapy or brachytherapy (7–12%), all modalities have high impotence (±75%) and urethral stricture rates (±20%), and 45–55% of patients experience a relapse after 4 years [6]
This study shows that ultrafocal salvage high-dose-rate brachytherapy (HDR-BT) has limited effect on patient-reported bowel function and sexual activity but causes a increase in urinary symptoms and a decrease of sexual functioning over time

Summary

Introduction

As a result of treatment innovations and increased cancer survival, more attention is directed towards patient-reported outcomes such as health-related Quality of Life (HR-QoL). This trend is especially relevant for prostate cancer, with decreasing mortality rates in most countries despite increasing incidences [1]. Prostate cancer recurrences occur in 10–50% of patients 10 years after external beam radiotherapy (EBRT) [2]. Various whole gland salvage treatment modalities are available such as radical prostatectomy, low-dose-rate brachytherapy (LDR-BT), cryotherapy and HIFU, these are unpopular due to high failure and toxicity rates [5].

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