Abstract
Simple SummaryFor patients with localized prostate cancer (PCa), information on the quality of life (QOL) after treatment is important when determining their preferred treatment option. In external beam radiation therapy, moderate hypofractionation (MH) is becoming an alternative standard for PCa treatment and MH is increasingly used in proton therapy (PT). Although MHPT is a promising strategy, there is little evidence regarding the data of long-term QOL after MHPT. This study evaluated patient-reported QOL over three years after MHPT and compared the data with that after normofractionated PT (NFPT) using the Expanded Prostate Cancer Index Composite-50. We revealed urinary QOL was temporarily decreased with clinically meaningful changes at 1 month, but did not observe clinically meaningful QOL deterioration in other assessment points in the urinary, bowel, and sexual domains over three years after MHPT. In addition, the QOL after MHPT and NFPT was similar overall.We retrospectively evaluated the three-year patient-reported quality of life (QOL) after moderately hypofractionated proton therapy (MHPT) for localized prostate cancer in comparison with that after normofractionated PT (NFPT) using the Expanded Prostate Cancer Index Composite-50. Patients who received MHPT (60–63 Gy (relative biological effectiveness equivalents; RBE)/20–21 fractions) (n = 343) or NFPT (74–78 Gy (RBE)/37–39 fractions) (n = 296) between 2013 and 2016 were analyzed. The minimum clinically important difference (MCID) threshold was defined as one-half of a standard deviation of the baseline value. The median follow-up was 56 months and 83% completed questionnaires at 36 months. Clinically meaningful score deterioration was observed in the urinary domain at 1 month in both groups and in the sexual domain at 6–36 months in the NFPT group, but not observed in the bowel domain. At 36 months, the mean score change for urinary summary was −0.3 (MHPT) and −1.6 points (NFPT), and that for bowel summary was +0.1 and −2.0 points; the proportion of patients with MCID was 21% and 24% for urinary summary and 18% and 29% for bowel summary. Overall, MHPT had small negative impacts on QOL over three years, and the QOL after MHPT and NFPT was similar.
Highlights
Various treatment strategies exist for localized prostate cancer (PCa) and the cure rate does not vary greatly among them [1]
There were no significant differences between the normofractionated proton therapy (PT) (NFPT) and moderately hypofractionated proton therapy (MHPT) groups regarding age, T stage, Gleason score, NCCN risk category, prostate volume, clinical target volume (CTV) volume, comorbidity of hypertension and diabetes, or androgen-deprivation therapy (ADT) usage
Among the no ADT population, clinically meaningful deterioration was observed only in the NFPT group at several points from 6 to 36 months, there was no significant difference in the minimum clinically important difference (MCID) proportion between the groups. We considered it difficult to interpret the difference in potential impact on sexual quality of life (QOL) between NFPT and MHPT
Summary
Various treatment strategies exist for localized prostate cancer (PCa) and the cure rate does not vary greatly among them [1]. Recent technological advances have led to the emergence of multiple external beam radiation therapy (EBRT) strategies, including proton therapy (PT), for localized. Hypofractionated EBRT is widely used in current PCa treatments [7]. The general advantages of hypofractionation include improved patient convenience and resource utilization. It may provide an additional advantage due to the low α/β ratio of PCa [8,9]. Recent high conformal techniques enable dose escalation while minimizing unnecessary doses to healthy tissues. Hypofractionation with high conformal RT techniques is expected to improve the efficacy with less patient harm
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