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 2002–2010. 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 up to 3 years. Results Bowel QoL data at 3 years 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 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

Targeted Radiation and Immune Therapies—Advances and Opportunities for the Treatment of Prostate Cancer

“…Several studies have indicated that prostate cancer responds well to EBRT delivered in fewer fractions with higher doses (hypofractionation) [ 13 , 14 , 15 ]. Stereotactic body radiation therapy (SBRT), also called stereotactic ablative radiotherapy (SABR), is a technique that can deliver higher doses in hypofractionated regimens and has shown comparable biochemical control and morbidity to standard fractionation schedules in prospective randomized trials [ 13 , 16 ].…”

Normal tissue sparing using different techniques for prostate irradiation

“…Several dose-escalation studies [1][2][3][4][5] for localized prostate cancer (PCa) have shown advanced biochemical relapse-free (bRFS) rates and also better local control for higher total doses using either conventional (CFRT) or simultaneously integrated boost (SIB) schedules. Recently published results 6,7 show that prostate tumours have different biological properties to other tumour localizations.…”