title: Quality of Life after Post-Prostatectomy Intensity Modulated Radiation Therapy: Pelvic Nodal Irradiation Is Not Associated with Worse Bladder, Bowel, or Sexual Outcomes.
abstract: BACKGROUND
  Limited data exist regarding toxicity and quality of life (QOL) after post-prostatectomy intensity modulated radiation therapy (IMRT) and whether pelvic nodal RT influences these outcomes.
  
  
  METHODS
  118 men were treated with curative-intent RT after radical prostatectomy. 69 men (58%) received pelvic nodal RT. QOL data and physician-assigned toxicity were prospectively collected. Changes in QOL from baseline were assessed with Wilcoxon signed-rank tests and risk factors associated with each domain were identified with generalized estimating equation (GEE) models. Late freedom from (FF) toxicity was estimated by the Kaplan-Meier method and comparisons were tested using the log-rank test.
  
  
  RESULTS
  Urinary irritation/obstruction, bowel, and sexual domain scores declined at 2 months (all P ≤ 0.01) but were no different than baseline at subsequent visits through 4 years of follow-up. At 4 years, FF grade 2+ GI toxicity was 90% and FF grade 2+ GU toxicity was 89%. On GEE analysis, pelvic nodal RT was associated with decreased bowel function (P = 0.09) and sexual function (P = 0.01). On multivariate analysis, however, there was no significant association with either decreased bowel (P = 0.31) or sexual (P = 0.84) function. There was also no association with either FF grade 2+ GI toxicity (P = 0.24) or grade 2+ GU toxicity (P = 0.51).
  
  
  CONCLUSIONS
  Receipt of pelvic nodal RT was not associated with inferior QOL or toxicity compared to prostate bed alone RT. For the entire cohort, RT was associated with only temporary declines in patient-reported urinary, bowel, or sexual QOL.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: James M
authors.initials: JM
authors.lastname: Melotek
authors.affiliation: Department of Public Health Sciences, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Chuanhong
authors.initials: C
authors.lastname: Liao
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Liauw
mesh_terms: D000368:Aged; D015897:Comorbidity; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011184:Postoperative Period; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D011788:Quality of Life; D011832:Radiation Injuries; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012307:Risk Factors