ASTRO 2015: Hypofractionated Radiation Therapy May Be an Acceptable Treatment for Some Patients With Localized Prostate Cancer
Long-term patient-reported outcomes indicate that for some men with localized prostate cancer, hypofractionated intensity-modulated radiation therapy (IMRT) may be a reasonable treatment option and result in similar quality-of-life outcomes, compared to conventional radiation therapy, according to research presented by Shaikh et al on October 19, 2015, at the American Society for Radiation Oncology’s (ASTRO’s) 57th Annual Meeting in San Antonio, Texas.
Men diagnosed with prostate cancer have multiple treatment options. When determining which treatment option(s) will be best for each patient, careful consideration must be given to treatment-related side effects and long-term toxicity, because men diagnosed with prostate cancer often have a long life expectancy.
Although the body of literature on long-term quality-of-life outcomes in patients treated for prostate cancer is growing, there had previously been no long-term prospective data on quality-of-life outcomes following hypofractionated radiation therapy, which is given at a higher dose over a shorter period of time than conventional radiation therapy (which is typically given daily on a Monday through Friday schedule, over approximately 8 weeks at 2 Gy per fraction.)
Study Details
This prospective, phase III study was conducted from 2002 to 2006. A total of 303 men with low- to high-risk prostate cancer received randomized treatment, consisting of either conventional radiation therapy at 76 Gy in 38 fractions at 2.0 Gy per fraction, or hypofractionated at 70.2 Gy in 26 fractions at 2.7 Gy per fraction.
Patient-reported outcomes were gathered at a median follow-up of 69 months and compared using the Expanded Prostate Cancer Index Composite (EPIC) and International Prostate Symptom Score (IPSS) questionnaires; patient-reported outcome scores were reported as a mean at each time point. Changes from baseline (defined as score < 1 month prior to initiation of radiation therapy) were compared between treatment arms. Generalized estimating equation models were used to assess the effect of treatment over time.
Study Findings
Results of this study found that patient-reported outcomes were not statistically different with long-term follow-up in patients receiving conventional radiation therapy or hypofractionated radiation therapy for localized prostate cancer. Although EPIC scores indicated an initial decrease in quality-of-life scores in both groups, it subsequently improved.
There were no apparent differences in long-term quality-of-life outcomes in terms of bowel, sexual, hormonal, or general health status when comparing the two arms. Patients receiving hypofractionated radiation therapy initially appeared to have worse urinary incontinence at 3 to 4 years after treatment, although this subsequently resolved.
As with any treatment modality, patient selection is a key factor in delivering effective care. When examining both treatment groups, their baseline quality of life was the strongest predictor of quality of life at 48 months. Patients who have poor baseline urinary functional status should be counseled regarding the potential impact that hypofractionated radiation therapy may have on their long-term quality of life.
“Our results, which demonstrate that delivery of hypofractionated radiation is feasible in a select group of individuals, are not surprising,” said Talha Shaikh, MD, Resident in the Department of Radiation Oncology at Fox Chase Cancer Center. “Although physicians have often worried about delivering hypofractionated radiation therapy to the prostate, advanced radiation techniques have made delivery of high-dose conformal radiation with minimal toxicity increasingly attainable. In this era of health-care reform, reducing treatment time and cost while maintaining efficacy is intriguing.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
