title: Long-term Toxicity and Health-related Quality of Life after Single-fraction High Dose Rate Brachytherapy Boost and Hypofractionated External Beam Radiotherapy for Intermediate-risk Prostate Cancer.
abstract: OBJECTIVE
  To report health-related quality of life (HRQOL) and toxicity in prostate cancer patients treated with single-fraction high dose rate (HDR) brachytherapy boost and external beam radiotherapy (EBRT).
  
  
  METHODS
  Patients with intermediate-risk prostate cancer were accrued to a phase II clinical trial of 15 Gy HDR boost and EBRT to a dose of 37.5 Gy in 15 fractions. HRQOL (Expanded Prostate Cancer Index Composite [EPIC]), urinary symptoms (International Prostate Symptom Score [IPSS]), erectile function (International Index of Erectile Function [IIEF]) and toxicity (Common Terminology Criteria for Adverse Events [CTCAE], version 3.0) were monitored prospectively. Univariate and multivariate logistic regression analysis was used to investigate associations between HRQOL/toxicity and baseline covariates.
  
  
  RESULTS
  The median follow-up time was 5.2 years. The change in the median EPIC scores from baseline to year 5 in the urinary domain was from 91 to 85 (P = 0.0028), in the bowel domain was from 98 to 96 (P = 0.03), in the sexual domain was from 63 to 35 (P < 0.0001) and the hormonal domain remained unchanged at 95 (P = 0.93). Fifty-nine per cent and 46% of the patients with normal erectile function at baseline remained potent at year 1 and year 5, respectively. Late genitourinary toxicity grade 1, 2 and ≥3 occurred in 29, 59 and 4% of patients, respectively. The rates of late gastrointestinal toxicity grade 1, 2 and ≥3 were documented as 45, 19 and 0%, respectively. On multivariate logistic regression analysis, patients with larger prostates were more likely to develop a urinary late toxicity grade ≥2 (P = 0.01). The dose to 10% of the urethra was the only factor associated with a decline in the EPIC urinary domain score (P = 0.012). Prostate volume >43 ml was associated with higher late genitourinary toxicity grade ≥2.
  
  
  CONCLUSIONS
  Single 15 Gy HDR brachytherapy with EBRT has a low rate of late genitourinary and gastrointestinal toxicities. Late urinary morbidity may be minimised by limiting the dose to the urethra, particularly for patients with larger prostates.
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Shahid
authors.affiliation: Department of Radiation Oncology, Odette Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Loblaw
authors.affiliation: Department of Radiation Oncology, Odette Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: H T
authors.initials: HT
authors.lastname: Chung
authors.affiliation: Department of Radiation Oncology, Odette Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Cheung
authors.affiliation: Department of Radiation Oncology, Odette Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Szumacher
authors.affiliation: Department of Radiation Oncology, Odette Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Danjoux
authors.affiliation: Department of Medical Physics, Odette Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Sankreacha
authors.affiliation: Department of Clinical Trials and Epidemiology, Odette Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Clinical Trials and Epidemiology, Odette Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Deabreu
authors.affiliation: Department of Clinical Trials and Epidemiology, Odette Cancer Center, University of Toronto, Toronto, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Mamedov
authors.affiliation: Department of Radiation Oncology, Odette Cancer Center, University of Toronto, Toronto, Canada. Electronic address: gerard.morton@sunnybrook.ca.
authors.forename: G
authors.initials: G
authors.lastname: Morton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000150:complications / Q000532:radiotherapy*; D011788:Quality of Life / Q000523:psychology*; D000069473:Radiation Dose Hypofractionation; D011832:Radiation Injuries / Q000209:etiology*; D011879:Radiotherapy Dosage
keywords: Brachytherapy; health-related quality of life; prostate cancer; toxicity