Promising Long-Term Health-Related Quality of Life After High-Dose-Rate Brachytherapy Boost for Localized Prostate Cancer

Wahlgren, Thomas; Nilsson, Sten; Lennernäs, Bo; Brandberg, Yvonne

doi:10.1016/j.ijrobp.2007.04.001

Cited by 17 publications

(8 citation statements)

References 20 publications

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“…HRQoL data on the combined HDRBT-EBRT treatment are limited. However, similar to our findings, a study of HRQoL 5 years after treatment in a cohort of PC patients given HDR brachytherapy and EBRT indicated that urinary symptoms were more common than bowel symptoms (21). The authors suggested that the standard strategy applied at the time of their investigation (i.e., assuming that a central position of the urethra represents a good estimate of the location of urethra, when defining the treatment dose) might have led to administration of higher doses to the urethra than intended and hence affected the incidence of treatment-induced chronic urethritis.…”

Section: Univariate Analysissupporting

confidence: 91%

Long-term health-related quality of life after curative treatment for prostate cancer: A regional cross-sectional comparison of two standard treatment modalities

Hjälm-Eriksson

Lennernäs

Ullén

et al. 2014

International Journal of Oncology

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Abstract. Effects on long-term health-related quality of life (HRQoL) were evaluated in patients treated for localized prostate cancer by two standard modalities: radical retropubic prostatectomy (RP) and external beam radiotherapy combined with a high-dose-rate brachytherapy boost (HDRBT-EBRT). The HRQoL data were compared with age-adjusted normative data. Men diagnosed with localized prostate cancer and treated with curative intent in Gothenburg, Sweden, 1988Sweden, -1997 were included. HRQoL was measured in October 2000 using the EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires, with a response rate of 82% (n=347). No differences in patient characteristics were found between the two treatment groups, except regarding tumor stage and PSA recurrence at the time of the questionnaires. In the RP group, 42% had T1 and 6% had T3-4 tumors; corresponding proportions in the HDRBT-EBRT group were 29% and 13% (P=0.01). PSA recurrence was detected in 44% of RP patients and 9% of HDRBT-EBRT patients. In most domains, mean HRQoL scores were high and similar to the scores for the age-adjusted normative sample. However, patients reported better role and physical function compared to the normal population. We also observed more sleeping disturbances but less pain among patients than in the normal population. The disease-specific questionnaires showed statistically significant higher levels of bowel and urinary problems in the irradiated group than in the RP group, and the absolute difference between the groups was small and had minor clinical significance. We conclude that overall the general quality of life was rated high by the patients irrespective of curative treatment modality and in agreement with age-adjusted normative data. Statistically significant differences in bowel and urinary symptoms were found between the two treatment groups in favor of the RP group, but the clinical significance was small.

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Section: Univariate Analysissupporting

confidence: 91%

Long-term health-related quality of life after curative treatment for prostate cancer: A regional cross-sectional comparison of two standard treatment modalities

Hjälm-Eriksson

Lennernäs

Ullén

et al. 2014

International Journal of Oncology

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“…The patients in the current investigation had slightly better scores on almost all items of the HRQoL (EORTC QLQ-C30) after 4-year follow-up compared with predicted values from an age-matched healthy population and the results presented by Wahlgren et al and Michelson et al (18,19). Surprisingly, sexual functioning was not poorer in patients evaluated in the present series.…”

Section: Discussionsupporting

confidence: 55%

“…In Table IV, the results for each domain of the two questionnaires are shown together with predicted values for the general population in Sweden and values obtained in a Swedish longterm follow-up of men with localized prostate cancer ≥5 years after brachytherapy (18,19).…”

Section: 6mentioning

confidence: 99%

Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: Single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy

Cortés-González

Castellanos

Sandberg

et al. 2012

International Journal of Oncology

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The aim of this study was to investigate the role of 70 Gy salvage radiotherapy (SRT) combined with short-term neoadjuvant hormonal therapy (NHT) in the treatment of recurrent disease after radical prostatectomy (RP), and to consider quality of life (QoL), survival outcomes and impact of co-morbidities on treatment-related rectal-genitourinary toxicity. Electronic records of 184 SRT patients treated consecutively between October 2001 and February 2007 were analyzed. Median age was 64 years (median follow-up 48 months). NHT was given to 165 patients (median 3 months). Pre-RP and pre-SRT PSA, PSA doubling time, Gleason score (GS), seminal vesicle invasion (SVI) and detectable post-SRT PSA were recorded. Any detectable PSA or PSA >0.1 ng/ml + nadir was considered biochemical failure (BcF). The Charlson co-morbidity index was used to correlate co-morbidities and rectal-genitourinary toxicity. Scores from the health-related QoL EORTC QLQ-C30 and PR-25 questionnaires were also evaluated. In 116 (63%) patients, a long-lasting curative effect was indicated by undetectable PSA levels. In univariate analysis, using BcF as an outcome variable, p<0.001 was found for GS, pre-SRT PSA, SVI and detectable post-SRT PSA. Multivariate analysis showed p=0.01 for SVI, p=0.09 for GS, and detectable post-SRT PSA (p=0.01); with metastases as an outcome variable, only SVI was significant (p=0.007). Cancer-specific and overall survival were 99 and 95%, respectively. Although microscopy showed SVI or GS 8-10 in the prostatectomy specimens 17/40 (43%) and 13/29 (45%), respectively, of patients still showed undetectable PSA at long-term follow-up (median 55 months) after SRT. Likewise, 11/31 (36%) patients with pre-SRT PSA >1.0 ng/ml and 80/134 (60%) patients with PSA doubling time (PSADT) <10 still showed undetectable PSA after 50 months. Slightly elevated acute and late rectal-genitourinary grade 3-4 toxicity was observed. No association with co-morbidity/toxicity was found. EORTC QLQ-C30 scores were similar to or slightly better than reference values. SRT with 70 Gy combined with 3-month NHT results in long-term undetectable PSA in >50% of patients with recurrence after RP with acceptable rectal-genitourinary toxicity and without negatively affecting long-term QoL. Non-metastatic patients should not be disqualified from receiving SRT although presenting with poor prognostic factors at surgery.

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“…HRQoL differences may not become apparent at the end of one to two years of completion of treatment and hence a longer follow up might be helpful to see the difference. Wahlgren T et al reported the five year disease-specific HRQoL of patients with localized prostate cancer following combined treatment including EBRT, HDRBT and hormone therapy [17]. The long term data reported that only minor differences in general HRQoL compared with normative data.…”

Section: Discussionmentioning

confidence: 99%

Analysis of health related quality of life (HRQoL) of patients with clinically localized prostate cancer, one year after treatment with external beam radiotherapy (EBRT) alone versus EBRT and high dose rate brachytherapy (HDRBT)

et al. 2008

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PurposeProstate cancer is the leading form of cancer diagnosed among North American men. Most patients present with localized disease, which can be effectively treated with a variety of different modalities. These are associated with widely different acute and late effects, which can be both physical and psychological in nature. HRQoL concerns are therefore important for these patients for selecting between the different treatment options.Materials and methodsOne year after receiving radiotherapy for localised prostate cancer 117 patients with localized prostate cancer were invited to participate in a quality of life (QoL) self reported survey. 111 patients consented and participated in the survey, one year after completion of their treatment. 88 patients received EBRT and 23 received EBRT and HDRBT. QoL was compared in the two groups by using a modified version of Functional Assessment of Cancer Therapy-Prostate (FACT-P) survey instrument.ResultsOne year after completion of treatment, there was no significant difference in overall QoL scores between the two groups of patients. For each component of the modified FACT-P survey, i.e. physical, social/family, emotional, and functional well-being; there were no statistically significant differences in the mean scores between the two groups.ConclusionIn prostate cancer patients treated with EBRT alone versus combined EBRT and HDRBT, there was no significant difference in the QoL scores at one year post-treatment.

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Promising Long-Term Health-Related Quality of Life After High-Dose-Rate Brachytherapy Boost for Localized Prostate Cancer

Cited by 17 publications

References 20 publications

Long-term health-related quality of life after curative treatment for prostate cancer: A regional cross-sectional comparison of two standard treatment modalities

Long-term health-related quality of life after curative treatment for prostate cancer: A regional cross-sectional comparison of two standard treatment modalities

Early salvage radiation therapy combined with short-term hormonal therapy in recurrent prostate cancer after radical prostatectomy: Single-institution 4-year data on outcome, toxicity, health-related quality of life and co-morbidities from 184 consecutive patients treated with 70 Gy

Analysis of health related quality of life (HRQoL) of patients with clinically localized prostate cancer, one year after treatment with external beam radiotherapy (EBRT) alone versus EBRT and high dose rate brachytherapy (HDRBT)

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