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ASTRO 2016: Hypofractionated Radiation Therapy Can Reduce Treatment Time With Comparable Quality of Life for Patients With Prostate Cancer

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Key Points

  • Following treatment, patients who received higher doses in fewer sessions (the HRT group) reported similar health-related quality of life as the patients who received conventional doses (the CRT group).
  • There were no differences in change scores for either group on any EPIC domain at 6 months follow-up. At 12 months follow-up, hypofractionation patients reported a larger decline in the bowel domain compared to those who received CRT, but the change was not deemed clinically significant to patients.
  • “This research shows that hypofractionated radiation therapy offers patients value-based care for their disease… they can live equally long and have the same quality of life outcomes with 28 daily treatments, compared to what has been the standard care of 41 daily treatments. This reduction of treatment time by almost a third translates into other types of value for patients, such as decreased drive time, lower transportation costs, and fewer days off of work,” said researchers.

For men with early stage, low-risk prostate cancer, treatment with hypofractionated radiation therapy offers comparable health-related quality of life outcomes in one-third less treatment time than conventional radiation therapy, according to research presented by Watkins Bruner et al at the 58th Annual Meeting of the American Society for Radiation Oncology (ASTRO).

While efficacy results from NRG Oncology/RTOG 0415 were reported previously, this study is the first to report patient-reported outcomes from the trial, which included patients from across the U.S. and Canada. This trial assessed the differences in health-related quality of life—including bowel, urinary, sexual, and hormonal side effects—following a conventional or fractionated radiation therapy schedule. Compared to conventional radiation therapy (CRT), hypofractionated radiation therapy (HRT) is delivered in larger doses over a shorter period of time.

“Studies have suggested that higher amounts of radiation over shorter periods of time might be more effective in destroying cancer cells, but the concern has been that stronger doses might also cause quality of life issues such as more diarrhea or decrease in sexual function,” said lead study author Deborah Watkins Bruner, PhD, Professor at the Nell Hodgson Woodruff School of Nursing and Professor of Radiation Oncology at Emory University School of Medicine.

Study Details

Patients in the study were randomly assigned to receive either CRT, consisting of 73.8 Gy in 41 daily treatments delivered over 8.2 weeks, or HRT, consisting of 70 Gy in 28 daily treatments delivered over 5.6 weeks. A total of 962 patients reported health-related quality-of-life data, including 478 men from the CRT group and 448 men from the HRT group. The median patient age was 67 years, and baseline characteristics were similar between the treatment groups.

Health-related quality of life was assessed with the Expanded Prostate Index Composite (EPIC), a comprehensive instrument designed to evaluate patient-reported side effects after prostate cancer treatment. The questionnaire measured side effects in each of EPIC’s four domains—bowel, urinary, sexual, and hormonal. EPIC assesses prostate cancer-specific health-reated quality of life on a Likert scale with responses transformed to 0–100, where higher scores indicate a better health-related quality of life. Participant feedback was collected at baseline, 6 months after treatment began and 1 year post-treatment, with change scores compared between the CRT and HRT groups. A Wilcoxon test was used to assess differences.

Findings

At baseline, there were no statistically significant differences between treatment groups in any of the health-related quality-of-life domains. Results indicated that, compared to men without prostate cancer, most patients in both groups reported poor baseline EPIC sexual domain scores, with the CRT group’s score averaging 47.5 and the HRT group’s score averaging 44.2. At baseline, the groups reported only slightly lower than average bowel and urinary scores.

Following treatment, patients who received higher doses in fewer sessions (the HRT group) reported similar health-related quality of life as the patients who received conventional doses (the CRT group). There were no differences in change scores for either group on any EPIC domain at 6 months follow-up. At 12 months follow-up, hypofractionation patients reported a larger decline in the bowel domain compared to those who received CRT, with an average from baseline of -3.6 vs. -1.8, respectively, (P = .0037), but the change was not deemed clinically significant to patients.

“This research shows that hypofractionated radiation therapy offers patients value-based care for their disease. If patients with low-risk prostate cancer choose radiation therapy, they can live equally long and have the same quality of life outcomes with 28 daily treatments, compared to what has been the standard care of 41 daily treatments,” said Dr. Bruner. “This reduction of treatment time by almost a third translates into other types of value for patients, such as decreased drive time, lower transportation costs, and fewer days off of work.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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