Patient-reported quality of life after stereotactic body radiotherapy (SBRT), intensity modulated radiotherapy (IMRT), and brachytherapy.
OBJECTIVE
Stereotactic body radiotherapy (SBRT) is being used for prostate cancer, but concerns persist about toxicity compared to other radiotherapy options.


METHODS
We conducted a multi-institutional pooled cohort analysis of patient-reported quality of life (QOL) [EPIC-26] before and after intensity-modulated radiotherapy (IMRT), brachytherapy, or SBRT for localized prostate cancer. Data were analyzed by mean domain score, minimal clinically detectable difference (MCD) in domain score, and multivariate analyses to determine factors associated with domain scores at 2-years.


RESULTS
Data were analyzed from 803 patients at baseline and 645 at 2-years. Mean declines at 2-years across all patients were -1.9, -4.8, -4.9, and -13.3 points for urinary obstructive, urinary incontinence, bowel, and sexual symptom domains, respectively, corresponding to MCD in 29%, 20%, and 28% of patients. On multivariate analysis (vs. IMRT), brachytherapy had worse urinary irritation at 2-years (-6.8 points, p<0.0001) but no differences in other domains (p>0.15). QOL after SBRT was similar for urinary (p>0.5) and sexual domains (p=0.57), but was associated with better bowel score (+6.7 points, p<0.0002).


CONCLUSIONS
QOL 2-years after brachytherapy, IMRT, or SBRT is very good and largely similar, with small differences in urinary and bowel QOL that are likely minimized by modern techniques.
Department of Radiation Oncology, University of Michigan, Ann Arbor, United States.
Joseph R
JR
Evans
Department of Radiation Oncology, University of Michigan, Ann Arbor, United States.
Shuang
S
Zhao
Department of Biostatistics, University of Michigan, United States.
Stephanie
S
Daignault
Department of Urology, Emory University, Atlanta, United States.
Martin G
MG
Sanda
Department of Radiation Oncology, Washington University Medical Center, St. Louis, United States.
Jeff
J
Michalski
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, United States.
Howard M
HM
Sandler
Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, United States.
Deborah A
DA
Kuban
Department of Radiation Oncology, Cleveland Clinic, United States.
Jay
J
Ciezki
Beth Israel Deaconess Medical Center, Boston, United States.
Irving D
ID
Kaplan
Department of Radiation Oncology, Massachusetts General Hospital, Boston, United States.
Anthony L
AL
Zietman
Michigan State University, East Lansing, United States.
Larry
L
Hembroff
Department of Radiation Oncology, University of Michigan, Ann Arbor, United States.
Felix Y
FY
Feng
Georgetown University, Washington, United States.
Simeng
S
Suy
Department of Urology, University of Michigan, United States; HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States.
Ted A
TA
Skolarus
Department of Radiation Oncology, University of Michigan, Ann Arbor, United States.
Patrick W
PW
McLaughlin
Department of Urology, University of Michigan, United States.
John T
JT
Wei
Department of Urology, University of Michigan, United States.
Rodney L
RL
Dunn
21st Century Oncology, Ft Meyers, United States.
Steven E
SE
Finkelstein
21st Century Oncology, Ft Meyers, United States.
Constantine A
CA
Mantz
Georgetown University, Washington, United States.
Sean P
SP
Collins
Department of Radiation Oncology, University of Michigan, Ann Arbor, United States. Electronic address: dhamm@umich.edu.
Daniel A
DA
Hamstra
D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000523:psychology*; D015331:Cohort Studies; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D016634:Radiosurgery / Q000009:adverse effects / Q000523:psychology*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000523:psychology*; D057566:Self Report; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D014549:Urinary Incontinence / Q000209:etiology
Brachytherapy; IMRT; Prostate cancer; Quality of life; Stereotactic body radiotherapy (SBRT)