title: Quality of life after hypofractionated concomitant intensity-modulated radiotherapy boost for high-risk prostate cancer.
abstract: OBJECTIVE
  To evaluate the change in health-related quality of life (QOL) of patients with high-risk prostate cancer treated using hypofractionated radiotherapy combined with long-term androgen deprivation therapy.
  
  
  METHODS
  A prospective Phase I-II study enrolled patients with any of the following: clinical Stage T3 disease, prostate-specific antigen level ≥20 ng/mL, or Gleason score 8-10. Radiotherapy consisted of 45 Gy (1.8 Gy per fraction) to the pelvic lymph nodes with a concomitant 22.5 Gy intensity-modulated radiotherapy boost to the prostate, for a total of 67.5 Gy (2.7 Gy per fraction) in 25 fractions over 5 weeks. Daily image guidance was performed using three gold seed fiducials. Quality of life was measured using the Expanded Prostate Cancer Index Composite (EPIC), a validated tool that assesses four primary domains (urinary, bowel, sexual, and hormonal).
  
  
  RESULTS
  From 2004 to 2007, 97 patients were treated. Median follow-up was 39 months. Compared with baseline, at 24 months there was no statistically significant change in the mean urinary domain score (p = 0.99), whereas there were decreases in the bowel (p < 0.01), sexual (p < 0.01), and hormonal (p < 0.01) domains. The proportion of patients reporting a clinically significant difference in EPIC urinary, bowel, sexual, and hormonal scores at 24 months was 27%, 31%, 55%, and 60%, respectively. However, moderate and severe distress related to these symptoms was minimal, with increases of only 3% and 5% in the urinary and bowel domains, respectively.
  
  
  CONCLUSIONS
  Hypofractionated radiotherapy combined with long-term androgen deprivation therapy was well tolerated. Although there were modest rates of clinically significant patient-reported urinary and bowel toxicity, most of this caused only mild distress, and moderate and severe effects on QOL were limited. Additional follow-up is ongoing to characterize long-term QOL.
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Harvey
authors.initials: H
authors.lastname: Quon
authors.forename: Patrick C F
authors.initials: PC
authors.lastname: Cheung
authors.forename: D Andrew
authors.initials: DA
authors.lastname: Loblaw
authors.forename: Gerard
authors.initials: G
authors.lastname: Morton
authors.forename: Geordi
authors.initials: G
authors.lastname: Pang
authors.forename: Ewa
authors.initials: E
authors.lastname: Szumacher
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
authors.forename: Richard
authors.initials: R
authors.lastname: Choo
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mamedov
authors.forename: Andrea
authors.initials: A
authors.lastname: Deabreu
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D019583:Dose Fractionation, Radiation; D005270:Femur Head / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D058958:Organs at Risk / Q000000981:diagnostic imaging; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D011788:Quality of Life; D011859:Radiography; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012007:Rectum / Q000000981:diagnostic imaging; D012306:Risk; D001743:Urinary Bladder / Q000000981:diagnostic imaging
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen