Abstract
ObjectiveTo determine late toxicity and quality of life (QoL) in patients with localized prostate cancer after high-dose intensity-modulated radiotherapy (IMRT).Patient and methodsThis was a prospective study in patients with localized prostate adenocarcinoma who had been treated by IMRT (76 Gy) between February and November 2006. Physicians scored acute and late toxicity using the Common Terminology Criteria for Adverse Events (version 3.0). Patients completed cancer and prostate-specific QoL questionnaires (EORTC QLQ-C30 and QLQ-PR25) before IMRT (baseline) and at 2, 6, 18 and 54 months.ResultData were available for 38 patients (median age, 73 years) (18% low risk; 60% intermediate risk; 32% high risk). The incidence of urinary and gastrointestinal toxicity was respectively: immediately post IMRT: 36.8% and 23.7% (grade 1), 5.3% and 5.3% (grade 2), 2.6% and 0% (grade 3); at 18 months: 23.7% and 10.3% (grade 1), 26.3% and 13.2% (grade 2), 0% and 2.6% (grade 3); at 54 months: 34.2% and 23.7% (grade 1), 5.3% and 15.8% (grade 2), 5.3% and 0% (grade 3). At 54 months, significant worsening was reported by patients for 11/19 QoL items but the worsening was clinically relevant (>10 points) for 7 items only: physical, role as well as social functioning, fatigue, pain, dyspnoea and constipation. There was no significant difference between 54-month and baseline QoL scores for global health, gastrointestinal symptoms, treatment-related symptoms and sexual function. However, there was significant - but clinically non-relevant (<10 points) - worsening of urinary symptom.ConclusionHigh-dose IMRT to the prostate with accurate patient positioning did not induce any clinically relevant worsening in late urinary and gastrointestinal QoL at 54 months. Impaired physical and role functioning may be related to age and comorbidities.
Highlights
In patients with localized prostate cancer and a good prognosis, the efficacy of external beam is similar to that of surgery or brachytherapy [1,2,3]
In 2006, we initiated a prospective study of the toxicity and quality of life (QoL) associated with high-dose intensity-modulated radiotherapy (IMRT) for localized prostate cancer
We describe longer term results (54 months) to confirm good tolerance of this treatment after a long-term follow-up. Patients and methods This prospective study was performed in the Radiotherapy Department of the “Integrated Center of Oncology René Gauducheau” and included all consecutive patients with localised prostate cancer who were eligible for IMRT without nodal irradiation between February and December 2006
Summary
In patients with localized prostate cancer and a good prognosis, the efficacy of external beam is similar to that of surgery or brachytherapy [1,2,3]. Long-term QoL after IMRT has received attention in a limited number of prospective studies [18,19] even though adverse effects are known to occur late (over 30 months) [20,21]. In 2006, we initiated a prospective study of the toxicity and QoL associated with high-dose IMRT for localized prostate cancer. Results for 18 months of follow-up have been published [22]. We describe longer term results (54 months) to confirm good tolerance of this treatment after a long-term follow-up
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