A Comparison between Patient- and Physician-Reported Late Radiation Toxicity in Long-Term Prostate Cancer Survivors

Nuijens, Anna C.; Oei, Arlene L.; Bouhuijs, Anne; Franken, Nicolaas A.P.; Rasch, C.; Stalpers, Lukas J.A.

doi:10.3390/cancers14071670

Cited by 6 publications

(5 citation statements)

References 41 publications

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“…PC PROs do not always show concordance between patients and medical providers; toxicity is often assigned greater severity by patients. 24,25 We can corroborate that compared to physicians, patients generally ascribe greater severity to their symptoms. Our pooled collaborative physician-graded toxicity analysis 14 showed no late GI or GU toxicity in 74.4% and 56.6% of patients, respectively.…”

Section: Discussionsupporting

confidence: 70%

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A pooled patient‐reported outcomes analysis of moderately hypofractionated proton beam therapy and photon‐based intensity modulated radiation therapy for low‐ or intermediate‐risk prostate cancer

Lukez,

Handorf,

Mendenhall

et al. 2023

The Prostate

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BackgroundWe sought to characterize and compare late patient‐reported outcomes (PROs) after moderately hypofractionated intensity modulated radiation therapy (IMRT) and proton beam therapy (PBT) for localized prostate cancer (PC).MethodsThis multi‐institutional analysis included low‐ or intermediate‐risk group PC patients treated with moderately hypofractionated radiation to an intact prostate stratified by treatment modality: IMRT or PBT. The primary outcomes were prospectively collected patient‐reported late gastrointestinal (GI) and genitourinary (GU) toxicity assessed by International Prostate Symptom Score (IPSS) and Expanded PC Index Composite (EPIC). Multivariable regression analysis (MVA) controlling for age, race, and risk group tested the effect of time, treatment, and their interaction.Results287 IMRT and 485 PBT patients were included. Intermediate risk group (81.2 vs. 68.2%; p < 0.001) and median age at diagnosis (70 vs. 67 years; p < 0.001) were higher in the IMRT group. On MVA, there was no significant difference between modalities. PBT IPSS did not differ from IMRT IPSS at 12 months (odds ratio [OR], 1.19; p = 0.08) or 24 months (OR, 0.99; p = 0.94). PBT EPIC overall GI function at 12 months (OR, 3.68; p = 0.085) and 24 months (OR 2.78; p = 0.26) did not differ from IMRT EPIC overall GI function. At 24 months, urinary frequency was no different between PBT and IMRT groups (OR 0.35; p = 0.096).ConclusionsThis multi‐institutional analysis of low‐ or intermediate‐risk PC treated with moderately hypofractionated PBT and IMRT demonstrated low rates of late patient‐reported GI and GU toxicities. After covariate adjustment, late GI and GU PROs were not significantly different between PBT or IMRT cohorts.

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Section: Discussionsupporting

confidence: 70%

“…PC PROs do not always show concordance between patients and medical providers; toxicity is often assigned greater severity by patients 24,25 . We can corroborate that compared to physicians, patients generally ascribe greater severity to their symptoms.…”

Section: Discussionmentioning

confidence: 50%

A pooled patient‐reported outcomes analysis of moderately hypofractionated proton beam therapy and photon‐based intensity modulated radiation therapy for low‐ or intermediate‐risk prostate cancer

Lukez,

Handorf,

Mendenhall

et al. 2023

The Prostate

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“…In these studies, there was a low agreement between symptoms experienced by patients and those observed and recorded by physicians. Usually, the physician underreported the severity of the symptoms (27,28). When evaluating gastrointestinal toxicity in our study, there was also underreporting of bowel problems by physicians.…”

Section: Comparison Of Frequencies Between Groups Ieff-5 Median Score...mentioning

confidence: 71%

Safer and More Convenient Modern Curative Radiotherapy for Patients With Early Prostate Cancer

REINIKAINEN,

LEHTINEN,

LUUKKAALA

et al. 2023

Anticancer Res

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Background/Aim: New fractionation schedules with modern tools are a very rapidly developing area in curative radiotherapy (RT) for early prostate cancer (PC). To apply these techniques in everyday clinical practice, we planned this phase II trial with different fractionation schedules and followed up patients using careful healthrelated quality of life (QoL) questionnaires for three years. Patients and Methods: Seventy-three PC patients with one or two intermediate PC risk factors according to the National Comprehensive Cancer Network criteria were recruited. Forty-two patients were treated with 78/2 Gy (conventional fractionation, CF) or 60/3 Gy (moderately hypofractionation RT, MHF), and 31 patients were treated with 36.25/7.25 Gy (stereotactic body RT, SBRT). Their PSA levels were measured, and QoL data were assessed for genitourinary (GU), gastrointestinal (GI), and sexual well-being between the baseline and three years after treatment. A Rectafix™ (RF) fixation device was used in 30 patients in the CF/MHF group. Results: Three years after radiotherapy (RT), there were no differences between the groups regarding GU, GI, sexual well-being, PSA response, or clinical outcomes. On QoL questionnaires, men in the SBRT group were more satisfied with their QoL at the end of RT. Urinary symptoms (p=0.004) and urinary incontinence were more common in the CF/MHF group (p=0.016) three months after RT. The use of RF reduced GI toxicity, especially urgency (p=0.002), at three years after RT. Conclusion: Modern, short, five-fraction stereotactic radiotherapy as a local curative treatment for PC is well tolerated and safe. Our novel results showing a decrease in GI toxicity using Rectafix™ fixation should be confirmed in future randomized trials. Prostate cancer has the highest incidence of all cancers inFinland. In 2021, approximately 5,200 new prostate cancers were diagnosed (1). Globally, prostate cancer was the second most common cancer diagnosis in men in 2020 (2). The treatment selection for prostate cancer depends on the patient's cancer risk stratification, which includes Gleason score (ISUP grade), T stage, and prostate specific antigen (PSA) levels (3). According to the European Association of Urology prostate cancer guidelines, management approaches for patients with early prostate cancer include radical prostatectomy, external beam radiation therapy, active surveillance, and brachytherapy (3). Early prostate cancer outcomes are excellent with all treatment options (4-6). In addition to PSA levels, treatment responses after RT could be easily followed with MRI (7). Quality of life (QoL) issues are discussed, and comorbidities are evaluated when the optimal treatment for prostate-confined cancer is selected.The aim of this study was to evaluate an optimal fractionation schedule for modern image-guided external beam radiation therapy in Finnish men with early prostate cancer considering treatment results and patient-reported quality-of-life outcomes (8). The benefits of the rectum immobilization device were also eva...

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“…However, a notable late effect of pelvic radiotherapy is infertility, particularly relevant in patients of childbearing age. Proper counseling and preventive measures are imperative to address this concern before administering radiotherapy (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy Related Bowel and Bladder Toxicity after Prostate Cancer Irradiation

Saif Ur Rehman,

Shafaq Maqsood,

Aneela Deevan

2024

JHRR

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Background: Pelvic radiotherapy is a primary treatment modality for organ-confined prostate cancer and early-stage endometrial cancer. While effective in improving survival rates and reducing recurrence, it is associated with a range of side effects that can impact patient quality of life. Objective: The study aimed to assess the incidence, management, and resolution of acute and chronic side effects of pelvic radiotherapy in prostate and endometrial cancer patients, focusing on bowel and bladder functions. Methods: This single-center, observational study included 50 patients diagnosed with prostate or endometrial cancer who underwent pelvic radiotherapy with a dose of 66-70 Gy using a four-field technique on a linear accelerator. Patients were assessed for bladder and bowel dysfunction, with follow-up at 6, 12, and 18 months post-treatment. Statistical analysis involved univariate weighted distribution of response frequencies and paired t-tests for ordinal scale scores, using SPSS version 25 for data analysis. Results: Of the participants, 22% experienced dysuria, 64% reported bladder outlet obstruction, and 20% had constipation. Acute bowel symptoms like diarrhea occurred in 32%, and chronic proctitis developed in 22% of patients. Urinary symptoms appeared by the third week and generally resolved within weeks; however, bowel symptoms persisted longer but returned to baseline by 18 months post-treatment. Approximately 70% of patients reported good tolerance to radiotherapy. Conclusion: Pelvic radiotherapy is effective in treating prostate and endometrial cancers but requires management of transient side effects to improve patient outcomes. Advanced radiotherapy techniques such as IMRT and 3D CRT have shown potential in reducing these side effects, emphasizing the need for continuous technological advancements and patient-centered care in radiotherapy.

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A Comparison between Patient- and Physician-Reported Late Radiation Toxicity in Long-Term Prostate Cancer Survivors

Cited by 6 publications

References 41 publications

A pooled patient‐reported outcomes analysis of moderately hypofractionated proton beam therapy and photon‐based intensity modulated radiation therapy for low‐ or intermediate‐risk prostate cancer

A pooled patient‐reported outcomes analysis of moderately hypofractionated proton beam therapy and photon‐based intensity modulated radiation therapy for low‐ or intermediate‐risk prostate cancer

Safer and More Convenient Modern Curative Radiotherapy for Patients With Early Prostate Cancer

Radiotherapy Related Bowel and Bladder Toxicity after Prostate Cancer Irradiation

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