Quality of Life in Patients Who Underwent Intensity-Modulated Radiation Therapy, 125 I Brachytherapy, and Combined 125 I Brachytherapy Plus Three-Dimensional Conformal Radiation Therapy for Prostate Cancer

Abstract

To evaluate quality of life (QOL) in patients who underwent intensity-modulated radiation therapy (IMRT), I125 brachytherapy (BT), and BT combined with three-dimensional conformal radiation therapy (BT + 3D-CRT) for prostate cancer (PCa) patients. We conducted a prospective trial to evaluate health-related QOL for patients who underwent IMRT, BT, and BT + 3D-CRT. QOL was estimated by the Expanded Prostate Cancer Index Composite (EPIC) questionnaire before each treatment and at 1, 3, 6, 12, and 24 months. Multivariate analyses were conducted to determine factors associated with lowering urinary and bowel domain scores at 12 months from baseline. Data were analyzed from 555 (IMRT: n = 123, BT: n = 227, BT + 3D-CRT: n = 205) at 12 months. Mean change in the urinary summary score at 12 months was −0.01, −3.4, and −4.1 points among patients treated with IMRT, BT, and BT + 3D-CRT, respectively. Mean change in the bowel summary score at 12 months was −3.5, −1.1, and −2.8 points among patients treated with IMRT, BT, and BT + 3D-CRT, respectively.On multivariate analysis of factors that predict a lower EPIC score of the urinary domain at 12 months, BT (OR 1.91, 95% CI 1.11–3.28) and BT + 3D-CRT (OR 2.14, 95% CI 1.24–3.70) groups had lower urinary QOL at 12 months using the IMRT group as a reference. In addition, on multivariate analysis of factors that predict a lower EPIC score of the urinary domain at 24 months, BT (OR 1.82, 95% CI 1.04–3.20) and BT + 3D-CRT (OR 3.11, 95% CI 1.77–5.48) groups had lower urinary QOL using the IMRT group as a reference.On multivariate analysis of factors predicting a lower EPIC score in the bowel domain, the BT + 3D-CRT (OR 1.59, 95% CI 1.06–2.37) and IMRT (OR 2.22, 95% CI 1.33–3.74) groups had lower bowel QOL using the BT group as a reference at 12 months. In addition, on multivariate analysis of factors that predict a lower EPIC score of the bowel domain at 24 months, the BT + 3D-CRT (OR 1.59, 95% CI 1.02–2.49) and IMRT (OR 1.68, 95% CI 1.002–2.82) groups had lower bowel QOL using the BT group as a reference. Knowledge of changes in QOL outcomes associated with IMRT, BT, and BT + 3D-CRT may influence treatment recommendations and enable patients to make better-informed decisions.