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Patient-Reported Functional Outcomes With Hypofractionated vs Conventionally Fractionated Radiotherapy for Nonmetastatic Prostate Cancer


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In a national cohort study conducted in the United Kingdom and reported in the Journal of Clinical Oncology, Nossiter et al found no clinically important differences in patient-reported functional outcomes among men receiving hypofractionated vs conventionally fractionated radiotherapy for nonmetastatic prostate cancer.

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Study Details

In the study, all men (n = 17,058) diagnosed with nonmetastatic prostate cancer between April 2014 and September 2016 in the English National Health Service who underwent conventionally fractionated or hypofractionated radiotherapy were identified from the National Prostate Cancer Audit and mailed a questionnaire at least 18 months after diagnosis. The study assessed patient-reported urinary, bowel, sexual, and hormonal function using Expanded Prostate Cancer Index Composite short-form 26 domain scores (0–100 scale; higher score = worse function) and health-related quality of life using the EuroQol EQ-5D-5L (0–1 scale, higher score = worse function), with adjustment for patient-, tumor-, and treatment-related factors and baseline gastrointestinal  and genitourinary function.

Key Findings

Overall, 77% of patients responded, including 8,432 who received conventionally fractionated radiotherapy (64%) and 4,699 who received hypofractionated radiotherapy (36%). Patients in the hypofractionated group were older (68% vs 61% ≥ 70 years), less likely to have locally advanced disease (57% vs 71%), less likely to receive androgen-deprivation therapy (80% vs 88%), and more likely to have had pretreatment genitourinary procedures (24% vs 21%).

KEY POINTS

  • Compared with conventionally fractionated radiotherapy, hypofractionated radiotherapy was associated with statistically significant increases in adjusted mean scores for sexual function and hormonal function; however, the differences failed to meet accepted criteria for minimal clinically important difference in the sexual function domain or hormonal function domain.
  • No clinically or statistically significant differences for hypofractionated vs conventionally fractionated radiotherapy were observed in urinary function, bowel function, or EQ-5D-5L quality of life score.

Compared with conventionally fractionated radiotherapy, hypofractionated radiotherapy was associated with statistically significant increases in adjusted mean scores for sexual function (3.3 points, P < .001) and hormonal function (3.2 points, P < .001); however, the differences failed to meet accepted criteria for minimal clinically important difference (MCID) in the sexual function domain (10–12 points) or hormonal function domain (4–6 points).

No clinically or statistically significant differences for hypofractionated vs conventionally fractionated radiotherapy were observed in urinary function (incontinence = -0.46 points, P = .34, MCID = 6–9 points; irritative, obstructive = -0.71 points, P =.098, MCID = 5–7 points), bowel function (0.97 points, P = .09, MCID = 4–6 points), or EQ-5D-5L quality of life score (0.0006, P = .87).

The investigators concluded, “This is the first national cohort study comparing functional outcomes after [hypofractionated radiotherapy] and [conventionally fractionated radiotherapy] reported by patients. These real-world results further support the use of hypofractionated radiotherapy as the standard for radiation therapy in men with nonmetastatic [prostate cancer].”

Julie Nossiter, PhD, of the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

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®.
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