Consequential late effects after radiotherapy for prostate cancer - a prospective longitudinal quality of life study

Abstract

BackgroundTo answer the question if and to which extent acute symptoms at the end and/or several weeks after radiotherapy can predict adverse urinary and gastrointestinal long-term quality of life (QoL).MethodsA group of 298 patients has been surveyed prospectively before (time A), at the last day (B), two months after (C) and >one year after (D) radiotherapy using a validated questionnaire (Expanded Prostate Cancer Index Composite). A subgroup of 10% with the greatest urinary/bowel bother score decrease at time D was defined as patients with adverse long-term QoL.ResultsSubgroup and correlation analyses could demonstrate a strong dependence of urinary/bowel QoL after radiotherapy on urinary/bowel QoL before radiotherapy. In contrast to absolute scores, QoL score changes (relative to baseline scores) did not correlate with pretreatment scores. Long-term changes could be well predicted by acute changes. Patients reporting great/moderate bother with urinary/bowel problems at time C reported to have great/moderate bother at time D in ≥ 50%, respectively. In a multivariate analysis of factors for adverse long-term urinary and bowel QoL, score changes at time C were found to be independent predictors, respectively. Additionally, QoL changes at time B were independently predictive for adverse long-term bowel QoL.ConclusionsConsequential late effects play a major role after radiotherapy for prostate cancer. Patients with greater and particularly longer non-healing acute toxicity are candidates for closer follow-up and possible prophylactic actions to reduce a high probability of long-term problems.

Combination of Dose Escalation with Technological Advances (Intensity-Modulated and Image-Guided Radiotherapy) Is Not Associated with Increased Morbidity for Patients with Prostate Cancer

“…Unfortunately, the actual symptoms leading to grade 2 or higher toxicities were not reported. Comparable to our finding reported in a recent publication [18], Zelefsky et al [30] report acute symptoms to be important precursors of late toxicities.…”

Pelvic symptoms after radiotherapy in prostate cancer: a cross-sectional study

“…Other study [21] also reinforces our findings in the QoL assessment. The study explored the longterm impact of acute and/or late RT symptoms on QoL.…”

“…Long-term changes can be predicted by post-RT acute alterations. That is, patients reporting urinary and bowel problems ranging from major to moderate during timeframe C had great to moderate inconvenience due to the same complaints in ≥ 50% of these patients during D. In addition, changes in QoL scores during B were independently predictive of poorer longterm QoL, despite the different QoL assessment tools used here compared to the study above [21]. Our results reinforce the same conclusions of the Pinkawa et al: patients who had no improvement in acute toxicity were candidates for a closer followup examination to identify possible preventive actions that could reduce the high probability of long-term problems.…”

Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia

“…Another possible explanation for the findings in our study is consequential late toxicity [17][18][19][20]. This is based on the assumption that the radiation dose causes both acute and late toxicity, while the acute toxicity by itself sets in motion a series of effects that ultimately lead to late toxicity.…”