Quality of Life with Hypofractionated Radiotherapy in Patients with Low-Risk Prostate Cancer

TOP - November 2016, Vol 9, No 4 - Conference Correspondent
Alice Goodman

Boston, MA—Hypofractionated radiotherapy achieves comparable quality of life compared with conventional radiotherapy, and has the advantages of shorter treatment time, greater convenience to the patient, and less cost to the healthcare system compared with conventional radiotherapy. The hypofractionated radiotherapy schedule is value-based, noted experts at the 2016 Annual Meeting of the American Society for Radiation Oncology (ASTRO).

“Giving higher doses of radiotherapy in shorter courses [ie, hypofractionated radiotherapy] is safe and efficacious in men with low-risk prostate cancer. This treatment saves 2.5 weeks of treatment time, cutting down work absences, childcare, and long drives needed for treatment. Also, this treatment is cheaper and will probably cut the copay. We submit that this study should change practice and that hypo­fractionated radiotherapy should be a standard of care for men with low-risk prostate cancer,” stated lead investigator Deborah Watkins Bruner, RN, PhD, FAAN, Nell Hodgson Woodruff School of Nursing and Emory University School of Medicine, Atlanta, GA.

“We hope that this will change ASTRO guidelines,” she added.

This study focused on adverse events from a noninferiority trial comparing the 2 treatment schedules in patients with low-risk prostate cancer. The primary results showed that hypofractionated radiotherapy was noninferior to conventional fractionation in achieving disease-free survival.

The original trial raised the concern that hypofractionated radiotherapy might cause more bowel toxicity, but Dr Watkins Bruner’s presentation at ASTRO laid that concern to rest by putting the results into clinical perspective. In the original study, grade 2 gastrointestinal toxicity was 18% in the hypofractionated radiotherapy arm, and 11% in the conventional radiotherapy arm. A similar trend was seen for genitourinary toxicity, with no differences between the 2 arms for other adverse events.

Her study looked at patient-reported outcomes to determine whether there were differences in toxicities that were clinically meaningful. The researchers used the Expanded Prostate Cancer Index Composite (EPIC), a 50-item scale scored from 0 to 4 (“none” to “worse”) to assess adverse events. Responses on EPIC were then transformed to a 0- to 100-point scale, with higher scores suggesting better outcomes. EPIC was measured at baseline and at 6 and 12 months.

No differences in hormonal effects and in urinary effects were observed between the treatment arms. For sexual function, a 15-point decrease was seen in the conventional radiation arm compared with an 11-point decrease in the hypofractionated radiotherapy arm, but this difference was not significant.

At 12 months, a 1.8-point difference was observed for bowel function favoring conventional radiation, but Dr Watkins Bruner said that this difference was not clinically significant, although it is statistically significant.

“Patients cannot tell the difference with a 1.8 difference. It might mean 3 bowel movements a day instead of 4, and patients don’t notice this. You need at least a 5-point jump for a patient to experience a difference,” she told listeners.

“We compared bowel and urinary function in patients treated with hypo­fractionated radiotherapy with normal patients, and we are almost at normal levels,” she stated.

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Last modified: January 9, 2017