Quality of Life (QOL) Outcomes After Three-Dimensional Conformal Radiation Therapy (3D-CRT) and Intensity Modulated Radiation Therapy (IMRT) for Localized Prostate Cancer

Abstract

Purpose/Objective: QOL outcomes are an important factor in evaluating therapeutic options for localized prostate cancer. Modern external beam radiation therapy techniques such as 3-D CRT or IMRT, are said to allow for safer dose escalation with the potential for decreased treatment related morbidity. Using the UCLA Prostate Cancer Index (PCI), a validated prostate cancer-specific, self-report QOL measure, we prospectively assessed health related QOL in men treated with 3D-CRT or IMRT for localized prostate cancer.Materials/Methods: The UCLA PCI was distributed to patients with localized prostate cancer at consultation and at one year following the completion of radiation therapy. Men who received either 3D-CRT or IMRT as their only local therapy are the topic of this report. The PCI measures QOL in 6 domains: urinary function (UF) and bother (UFBother), bowel function (BF) and bother (BFBother), and sexual function (SF) and bother (SFBother). Repeated measures analysis of variance were conducted to assess for change in the 0–100 standardized scale scores from baseline to one year, adjusting for 6 socio-demographic and disease variables: age at diagnosis, race, disease risk level, use of hormones, radiation dose and type of external beam radiation. We graphed summary scores of patients’ UF, BF and SF at baseline and at one year, stratifying by those patients who were high functioning at baseline vs. those who were lower functioning.Results: We examined 185 patients, treated between May 2001 and December 2003 by Valley Radiotherapy Associates of the greater Los Angeles area, who completed a baseline form within 6 months prior to radiation and at one year following completion of radiation (defined as between 9 and 15 months from end of radiation). Eighty patients received IMRT and 105 received 3D-CRT. Mean patient age was 70.5 years. Eighty-two percent of patients were Caucasian. The majority (65%) of patients were stage T1. Mean PSA was 8.3 and 62% of patients had Gleason grade ≤6 tumors. Mean (range) radiation dose was 7700 cGy (7200–7800). Forty-three percent in each group received hormones.There were no statistically significant differences in baseline urinary, bowel, or sexual functioning or bother between 3D-CRT and IMRT patients. Men treated with 3D-CRT experienced significant declines from baseline to one year in urinary and bowel function. However, men treated with IMRT had no significant change over time in urinary, bowel or sexual functioning. (Table)Those patients with excellent UF at baseline had a slight decline in mean scores at one year in both treatment groups (100 to 93.3 for whole sample). However, those patients with compromised urinary functioning at baseline showed mild improvement by one year in both treatment groups (78.4 to 81.5 for whole sample). Bowel and sexual functioning declined over one year regardless of baseline functioning in both treatment groups.Conclusions: Treatment of prostate cancer with IMRT compared to 3D-CRT may result in better preservation of urinary and bowel functioning at one year. Patients with poorer urinary functioning at baseline improve slightly by one year. Longer follow-up is required to assess long term results.Tabled 1*Probability from repeated measures ANOVA, adjusted for co-variates Purpose/Objective: QOL outcomes are an important factor in evaluating therapeutic options for localized prostate cancer. Modern external beam radiation therapy techniques such as 3-D CRT or IMRT, are said to allow for safer dose escalation with the potential for decreased treatment related morbidity. Using the UCLA Prostate Cancer Index (PCI), a validated prostate cancer-specific, self-report QOL measure, we prospectively assessed health related QOL in men treated with 3D-CRT or IMRT for localized prostate cancer. Materials/Methods: The UCLA PCI was distributed to patients with localized prostate cancer at consultation and at one year following the completion of radiation therapy. Men who received either 3D-CRT or IMRT as their only local therapy are the topic of this report. The PCI measures QOL in 6 domains: urinary function (UF) and bother (UFBother), bowel function (BF) and bother (BFBother), and sexual function (SF) and bother (SFBother). Repeated measures analysis of variance were conducted to assess for change in the 0–100 standardized scale scores from baseline to one year, adjusting for 6 socio-demographic and disease variables: age at diagnosis, race, disease risk level, use of hormones, radiation dose and type of external beam radiation. We graphed summary scores of patients’ UF, BF and SF at baseline and at one year, stratifying by those patients who were high functioning at baseline vs. those who were lower functioning. Results: We examined 185 patients, treated between May 2001 and December 2003 by Valley Radiotherapy Associates of the greater Los Angeles area, who completed a baseline form within 6 months prior to radiation and at one year following completion of radiation (defined as between 9 and 15 months from end of radiation). Eighty patients received IMRT and 105 received 3D-CRT. Mean patient age was 70.5 years. Eighty-two percent of patients were Caucasian. The majority (65%) of patients were stage T1. Mean PSA was 8.3 and 62% of patients had Gleason grade ≤6 tumors. Mean (range) radiation dose was 7700 cGy (7200–7800). Forty-three percent in each group received hormones. There were no statistically significant differences in baseline urinary, bowel, or sexual functioning or bother between 3D-CRT and IMRT patients. Men treated with 3D-CRT experienced significant declines from baseline to one year in urinary and bowel function. However, men treated with IMRT had no significant change over time in urinary, bowel or sexual functioning. (Table) Those patients with excellent UF at baseline had a slight decline in mean scores at one year in both treatment groups (100 to 93.3 for whole sample). However, those patients with compromised urinary functioning at baseline showed mild improvement by one year in both treatment groups (78.4 to 81.5 for whole sample). Bowel and sexual functioning declined over one year regardless of baseline functioning in both treatment groups. Conclusions: Treatment of prostate cancer with IMRT compared to 3D-CRT may result in better preservation of urinary and bowel functioning at one year. Patients with poorer urinary functioning at baseline improve slightly by one year. Longer follow-up is required to assess long term results. *Probability from repeated measures ANOVA, adjusted for co-variates