Toxicity and Health-related Quality of Life During and After High Dose Rate Brachytherapy Followed by External Beam Radiotherapy for Prostate Cancer

Abstract

Background:The optimal protocol for combining high dose rate brachytherapy and external beam irradiation as treatment for localized prostate cancer is unknown. Toxicity rates and clinical and biochemical outcomes should be evaluated to validate the current treatment protocol. Methods: Fifty-eight patients were treated for prostate cancer with high dose rate brachytherapy followed by 30 Gy of external beam radiation therapy. Toxicity during treatment and for 12-18 months thereafter, and treatment-related morbidity, were evaluated. Physician-assessed treatment-related toxicity was graded at the time of occurrence using the Radiation Therapy Oncology Group morbidity criteria. Four separate self-administered questionnaires were used to collect longitudinally demographic data and general and prostate disease-related measures of quality of life. Results: Various degrees of rectal bleeding due to radiation proctitis were experienced by 13 patients (22%) at a median time of 11 months. Two of these patients needed hospitalization to undergo laser coagulation of the rectal mucosa. Study patients had statistically significant decreases in five SF-36 domains during the first month of treatment. All measures recovered by 12 months. Sexual function was not affected by irradiation. Lower urinary tract symptoms assessed by IPSS/QOL scores worsened significantly during the first month of treatment but later recovered to baseline levels. Physician-assessed RTOG scores failed to detect these changes. Conclusions: Morbidity associated with combined radiation therapy was greatest during the first month of treatment and affected quality of life significantly. Most measures recovered to baseline levels by 12 months following radiation therapy. Although the current protocol appears acceptable, measures should be taken to decrease treatment-related morbidity further. Key words: prostate cancer -high dose rate brachytherapy -external beam radiotherapy -quality of life

Health-Related Quality of Life in I-125 Prostate Brachytherapy Patients Treated with and without Volume-Reducing Hormone Therapy: Results of a Short-Term Prospective Study

“…Most outcome measures, however, showed a recovery to baseline levels 12 months after radiation therapy. 20 Finally, a Swedish study on HRQOL after external beam radiotherapy and brachytherapy revealed that the negative contribution from neoadjuvant androgen deprivation therapy on symptom development seemed to be substantial but mostly transitory. 21 Our study also showed a decrease in HRQOL after treatment followed by an increase between 6 weeks and 3 months after treatment.…”

“…Emotional functioning 82 (20) 88 (15) 84 (21) 85 (18) 85 (21) 86 ( 89 (15) 90 (14) 85 (21) 90 (15) 84 (21) Ͻ0.050 Ͻ0.050…”

3-D conformal treatment of prostate cancer to 74 Gy vs. high-dose-rate brachytherapy boost: A cross-sectional quality-of-life survey

“…A Japanese group assessed HRQOL prospectively with the SF-36 questionnaire and self-formulated prostate-specific questions during the first 18 months after treatment with five times 4 to 5 Gy of HDR brachytherapy followed by ten 3-Gy fractions Table III of EBRT to the prostate and seminal vesicles [9]. While significant deterioration was seen in five domains of SF-36 at one month after radiotherapy, these values returned to normal by 12 months.…”

Clinical outcome in patients with prostate cancer treated with external beam radiotherapy and high dose-rate iridium 192 brachytherapy boost: A 6-year follow-up

“…The results are summarized in Table V. In addition, centres have reported their experience using the Syed free-style template technique [25,26]. There has been increasing experience with the use of HDR brachytherapy as a boost to external beam radiotherapy, and this has been evidenced in reports from a number of institutions of 5 years bNED survival in the range of 67 Á93%.…”

“…There is growing knowledge that self-assessed questionnaires are more sensitive when describing the presence of side effects compared to different methods where physician report the side effects [26,33,34]. However, the RTOG scores for acute and late radiation reactions have reached a consensus and a widespread use, which makes it practical when comparing different radiotherapy methods.…”