title: A comparative study of quality of life in patients with localized prostate cancer treated at a single institution: stereotactic ablative radiotherapy or external beam+high dose rate brachytherapy boost.
abstract: OBJECTIVE
  To compare the quality of life (QOL) in patients treated with stereotactic ablative radiation therapy (SABR) alone or high dose rate (HDR) brachytherapy+hypofractionated external beam radiotherapy (EBRT).
  
  
  METHODS
  Patient self-reported QOL was prospectively measured among patients from two sequential phase 2 clinical trials: 1-SABR 35Gy/5fractions/5 weeks, 2-15Gy HDR 1 fraction, followed by EBRT 37.5Gy/15 fractions/3 weeks. The expanded prostate cancer index composite was assessed at baseline and q6 monthly up to 5 years. Urinary, bowel and sexual domains were analyzed. A minimally clinical important change (MCIC) was defined as 0.5*standard deviation of the baseline for each domain. Fisher exact test and general linear mixed model were used (p<0.05).
  
  
  RESULTS
  84 and 123 patients were treated on the SABR and HDR boost studies, with a median follow up of 51 and 61 months respectively. There was a significant difference in MCIC between treatments in the urinary function and bother (p<0.0001), the bowel function (p=0.0216) and the sexual function (p=0.0419) and bother (p=0.0290) domains in favor of the SABR group. Of patients who reported no problem with their sexual function at baseline, 7% and 23% respectively considered it to be a moderate to big problem on follow up (p=0.0077).
  
  
  CONCLUSIONS
  Patients treated with HDR-boost reported deterioration of QOL particularly in sexual domains in comparison with SABR.
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Joelle
authors.initials: J
authors.lastname: Helou
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Gerard
authors.initials: G
authors.lastname: Morton
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Deabreu
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: D'Alimonte
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Elias
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Hima Bindu
authors.initials: HB
authors.lastname: Musunuru
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mamedov
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Ananth
authors.initials: A
authors.lastname: Ravi
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Hans
authors.initials: H
authors.lastname: Chung
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Cheung
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada; Department of Radiation Oncology, University of Toronto, Canada; Institute for Health, Policy, Measurement and Evaluation, University of Toronto, Canada. Electronic address: andrew.loblaw@sunnybrook.ca.
authors.forename: Andrew
authors.initials: A
authors.lastname: Loblaw
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life; D016634:Radiosurgery / Q000379:methods*; D014555:Urination Disorders / Q000209:etiology
keywords: High dose rate brachytherapy; Prostate cancer; Quality of life; Stereotactic ablative body radiotherapy