Impact of the target volume (prostate alone vs. prostate with seminal vesicles) and fraction dose (1.8 Gy vs. 2.0 Gy) on quality of life changes after external-beam radiotherapy for prostate cancer.
OBJECTIVE
To evaluate the impact of the clinical target volume (CTV) and fraction dose on quality of life (QoL) after external-beam radiotherapy (EBRT) for prostate cancer.


METHODS
A group of 283 patients has been surveyed prospectively before, at the last day, at a median time of 2 months and 15 months after EBRT (70.2-72 Gy) using a validated questionnaire (Expanded Prostate Cancer Index Composite). EBRT of prostate alone (P, n = 70) versus prostate with seminal vesicles (PS, n = 213) was compared. Differences of fraction doses (1.8 Gy, n = 80, vs. 2.0 Gy, n = 69) have been evaluated in the patient group receiving a total dose of 72 Gy.


RESULTS
Significantly higher bladder and rectum volumes were found at all dose levels for the patients with PS versus P within the CTV (p < 0.001). Similar volumes resulted in the groups with different fraction doses. Paradoxically, bowel function scores decreased significantly less 2 and 15 months after EBRT of PS versus P. 2 months after EBRT, patients with a fraction dose of 2.0 Gy versus 1.8 Gy reported pain with urination (> or = once a day in 12% vs. 3%; p = 0.04) and painful bowel movements (> or = rarely in 46% vs. 29%; p = 0.05) more frequently. No long-term differences were found.


CONCLUSIONS
The risk of adverse QoL changes after EBRT for prostate cancer cannot be derived from the dose-volume histogram alone. Seminal vesicles can be included in the CTV up to a moderate total dose without adverse effects on QoL. Apart from a longer recovery period, higher fraction doses were not associated with higher toxicity.
Pinkawa
Michael
M
Department of Radiotherapy, RWTH Aachen, Aachen, Germany. mpinkawa@ukaachen.de
Piroth
Marc D
MD
Fischedick
Karin
K
Holy
Richard
R
Klotz
Jens
J
Nussen
Sandra
S
Krenkel
Barbara
B
Eble
Michael J
MJ
D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D019583:Dose Fractionation, Radiation; D007172:Erectile Dysfunction / Q000523:psychology; D005242:Fecal Incontinence / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000528:radiation effects*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000523:psychology / Q000532:radiotherapy*; D011788:Quality of Life / Q000523:psychology*; D011832:Radiation Injuries / Q000523:psychology*; D011879:Radiotherapy Dosage; D012007:Rectum / Q000528:radiation effects; D012669:Seminal Vesicles / Q000528:radiation effects*; D011795:Surveys and Questionnaires; D001743:Urinary Bladder / Q000528:radiation effects; D014549:Urinary Incontinence / Q000523:psychology
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen