title: Patient-reported outcomes and health-related quality of life in prostate cancer treated with a single fraction of high dose rate brachytherapy combined with hypofractionated external beam radiotherapy.
abstract: OBJECTIVE
  High dose rate (HDR) brachytherapy offers a highly conformal approach to radiotherapy delivery, enabling dose escalation. We report our experience using a combined HDR boost and external beam radiotherapy (EBRT) approach and its associated toxicity and effect on quality of life.
  
  
  METHODS
  Patients with intermediate- or high-risk prostate cancer were treated with a single fraction HDR boost and EBRT between July 2008 and March 2010. Patient-reported toxicity data were collected at baseline and regular intervals after radiotherapy using International Prostate Symptom Score and Late Effects in Normal Tissues-Subjective, Objective, Management and Analytic scales (LENT-SOMA) questionnaires; health-related quality of life data were captured by the Expanded Prostate Cancer Index Composite (EPIC) questionnaire.
  
  
  RESULTS
  Ninety-five patients received an HDR boost of 12.5 Gy followed by EBRT delivered as 37.5 Gy in 15 fractions over 3 weeks. The International Prostate Symptom Score peaked 6 weeks after radiotherapy (median value: 9). The LENT-SOMA bladder/urethra mean baseline score was 0.35 and peaked 6 weeks after radiotherapy (mean = 0.59). Difficulties with urinary flow and frequency were the most common reported symptoms. LENT-SOMA rectum/bowel mean scores at baseline were 0.24 and peaked after 6 months (mean = 0.37). Bowel urgency was the most common reported toxicity. EPIC urinary scores returned to baseline values at 6 months and bowel median scores recovered after 24 months. There were no statistically significant associations between patient or dosimetric parameters and patient-reported outcomes.
  
  
  CONCLUSIONS
  A combined HDR boost and hypofractionated EBRT regimen offers a well-tolerated method of dose escalation with acceptable levels of patient-reported toxicity.
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK; Institute of Cancer Sciences, The University of Manchester, Manchester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Choudhury
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: C
authors.initials: C
authors.lastname: Arthur
authors.affiliation: Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
authors.forename: J
authors.initials: J
authors.lastname: Malik
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: P
authors.initials: P
authors.lastname: Mandall
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: C
authors.initials: C
authors.lastname: Taylor
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: N
authors.initials: N
authors.lastname: Alam
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Tran
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Livsey
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: T
authors.initials: T
authors.lastname: Elliott
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK; Institute of Cancer Sciences, The University of Manchester, Manchester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Davidson
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Logue
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK. Electronic address: james.wylie@christie.nhs.uk.
authors.forename: J
authors.initials: J
authors.lastname: Wylie
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011379:Prognosis; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology*; D057566:Self Report; D011795:Surveys and Questionnaires; D014521:Urethra / Q000528:radiation effects; D014555:Urination Disorders / Q000209:etiology
keywords: Brachytherapy; hypofractionation; patient-reported toxicity; prostate