title: Health-related quality-of-life changes due to high-dose-rate brachytherapy, low-dose-rate brachytherapy, or intensity-modulated radiation therapy for prostate cancer.
abstract: OBJECTIVE
  To compare urinary, bowel, and sexual health-related quality-of-life (HRQOL) changes due to high-dose-rate (HDR) brachytherapy, low-dose-rate (LDR) brachytherapy, or intensity-modulated radiation therapy (IMRT) monotherapy for prostate cancer.
  
  
  METHODS
  Between January 2002 and September 2013, 413 low-risk or favorable intermediate-risk prostate cancer patients were treated with HDR brachytherapy monotherapy to 2700-2800 cGy in two fractions (n = 85), iodine-125 LDR brachytherapy monotherapy to 14,500 cGy in one fraction (n = 249), or IMRT monotherapy to 7400-8100 cGy in 37-45 fractions (n = 79) without pelvic lymph node irradiation. No androgen deprivation therapy was given. Patients used an international prostate symptoms score questionnaire, an expanded prostate cancer index composite-26 bowel questionnaire, and a sexual health inventory for men questionnaire to assess their urinary, bowel, and sexual HRQOL, respectively, pretreatment and at 1, 3, 6, 9, 12, and 18 months posttreatment.
  
  
  RESULTS
  Median follow-up was 32 months. HDR brachytherapy and IMRT patients had significantly less deterioration in their urinary HRQOL than LDR brachytherapy patients at 1 and 3 months after irradiation. The only significant decrease in bowel HRQOL between the groups was seen 18 months after treatment, at which point IMRT patients had a slight, but significant, deterioration in their bowel HRQOL compared with HDR and LDR brachytherapy patients. HDR brachytherapy patients had worse sexual HRQOL than both LDR brachytherapy and IMRT patients after treatment.
  
  
  CONCLUSIONS
  IMRT and HDR brachytherapy cause less severe acute worsening of urinary HRQOL than LDR brachytherapy. However, IMRT causes a slight, but significant, worsening of bowel HRQOL compared with HDR and LDR brachytherapy.
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Tobin J
authors.initials: TJ
authors.lastname: Strom
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Alex A
authors.initials: AA
authors.lastname: Cruz
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Nick B
authors.initials: NB
authors.lastname: Figura
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Kushagra
authors.initials: K
authors.lastname: Shrinath
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Kevin
authors.initials: K
authors.lastname: Nethers
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Mellon
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Fernandez
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Amarjit S
authors.initials: AS
authors.lastname: Saini
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Dylan C
authors.initials: DC
authors.lastname: Hunt
authors.affiliation: Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL.
authors.forename: Randy V
authors.initials: RV
authors.lastname: Heysek
authors.affiliation: Cancer Treatment Centers of America, Newnan, GA. Electronic address: RichardBWilder@yahoo.com.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Wilder
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods*; D003672:Defecation / Q000528:radiation effects; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D053448:Prostatism / Q000209:etiology; D011788:Quality of Life; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012002:Rectal Diseases / Q000209:etiology*; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000209:etiology
keywords: Brachytherapy; Prostatic neoplasms; Quality of life; Radiotherapy