title: Quality of life outcomes from a dose-per-fraction escalation trial of hypofractionation in prostate cancer.
abstract: OBJECTIVE
  This multi-institutional phase I/II trial explored patient-assessed tolerance of increasingly hypofractionated (HPFX) radiation for low/intermediate risk prostate cancer.
  
  
  METHODS
  347 patients enrolled from 2002 to 2010. Three increasing dose-per-fraction schedules of 64.7 Gy/22 fx, 58.08 Gy/16 fx and 51.6 Gy/12 fx were each designed to yield equivalent predicted late toxicity. Three quality of life (QoL) surveys were administered prior to treatment and annually upto 3 years.
  
  
  RESULTS
  Bowel QoL data at 3years revealed no significant difference among regimens (p=0.469). Bowel QoL for all regimens declined transiently, largely recovering by three years, with only the 22 fraction decrement reaching significance. Bladder outcomes at 3 years were comparable (p=0.343) although, for all patients combined, a significant decline was observed from the baseline (p=0.008). Spitzer quality of life data revealed similarly excellent, 3-year means (p=0.188). International erectile function data also revealed no significant differences at 3 years although all measures except intercourse satisfaction worsened post-treatment.
  
  
  CONCLUSIONS
  Three-year QoL changes for bowel, bladder and SQLI were modest and similar for 3 HPFX regimens spanning 2.94-4.3 Gy per fraction. These favorable patient-scored outcomes demonstrate the safety and tolerability of such regimens and may be leveraged to support further implementation of mild to moderately hypofractionated radiotherapy in the setting of low and intermediate-risk prostate cancer.
authors.affiliation: Department of Human Oncology, University of Wisconsin Carbone Cancer Center, Madison, United States.
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Brower
authors.affiliation: Wayne State University, Detroit, United States.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Forman
authors.affiliation: UCLA Medical Center, Los Angeles, United States.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Kupelian
authors.affiliation: John T. Vucurevich Cancer Center Institute, Rapid City, United States.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Petereit
authors.affiliation: CDH Cancer Center, Warrenville, United States.
authors.forename: Vinai
authors.initials: V
authors.lastname: Gondi
authors.affiliation: Medical College of Wisconsin, Milwaukee, United States.
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Lawton
authors.affiliation: Department of Human Oncology, University of Wisconsin Carbone Cancer Center, Madison, United States.
authors.forename: Nick
authors.initials: N
authors.lastname: Anger
authors.affiliation: Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, United States.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Saha
authors.affiliation: Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, United States.
authors.forename: Rick
authors.initials: R
authors.lastname: Chappell
authors.affiliation: Department of Human Oncology, University of Wisconsin Carbone Cancer Center, Madison, United States. Electronic address: ritter@humonc.wisc.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ritter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007422:Intestines / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000528:radiation effects; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011788:Quality of Life; D000069473:Radiation Dose Hypofractionation; D011879:Radiotherapy Dosage; D011795:Surveys and Questionnaires; D001743:Urinary Bladder / Q000528:radiation effects
keywords: Hypofractionation; Prostate; Quality of life; SBRT