Health‐related quality of life 3 years after high‐dose intensity‐modulated radiotherapy with gold fiducial marker‐based position verification

Abstract

OBJECTIVE To evaluate the change in quality of life (QoL) 3 years after high‐dose intensity‐modulated radiotherapy (IMRT) using gold fiducial marker‐based position verification in patients with locally advanced prostate cancer. PATIENTS AND METHODS Between October 2003 and November 2004, 95 patients with locally advanced prostate cancer were treated with 76 Gy IMRT with gold‐fiducial marker‐based position verification. Before treatment (baseline) and 1, 6 and 36 months after RT the QoL was measured using the RAND‐36, the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (QLQ‐C30(+3)) and the prostate tumour‐specific module (EORTC QLQ‐PR25). Changes in QoL with time of ≥10 points were considered clinically relevant. RESULTS After 3 years there was a statistically significant improvement in QoL for emotional role restriction and functioning, change in health, mental health and insomnia, compared with baseline. Emotional role restriction increased by >10 points and was therefore clinically relevant, while all other differences were of <10 points. There was a statistically significant deterioration of QoL after 3 years in physical and cognitive functioning, bowel symptoms/function and sexual activity. Only the sexual activity QoL score changed by 12 points and was therefore the only meaningful deterioration in QoL at 3 years after treatment. CONCLUSION IMRT and accurate position verification provide the possibility to deliver a high irradiation dose to the prostate without clinically relevant deterioration in long‐term QoL, except for a persistent decrease in sexual activity score.

Longitudinal Analysis of Quality of Life in Patients Receiving Conformal Radiation Therapy for Prostate Cancer

“…Longitudinal studies on QoL in patients with CRT for prostate cancer are rare [2,14,16,18,19,27,30], and mostly have a follow-up of ≤ 1 year [2,14,16,18,27,30]. In concordance with our results, these studies demonstrate that QoL is not profoundly impaired by CRT and that there is only a temporary deterioration of a limited number of QoL domains during or shortly after therapy [14,18,27] [14].…”

“…In both groups, a temporary deterioration in physical role restriction and an improvement in emotional role restriction occurred. A recent publication of this study group disclosed a significant improvement of emotional role restriction and functioning, change in health, mental health, and insomnia 3 years after IMRT with 76 Gy for 95 patients as compared with baseline levels before treatment [19]. Sexual activity was significantly decreased at 3 years.…”

“…For the current evaluation, only the functional scales, the global QoL and the fatigue scale were considered, data on the remainder of the QLQ-C30 scales will be reported elsewhere. A change of 10% of the scale breadth or 10 points was considered clinically relevant [19,21]. Since determining a "clinically relevant change" in QoL scores is a matter of debate [21,26], all statistically significant changes are displayed in addition.…”

Therapeutic outcomes of neoadjuvant and concurrent androgen‐deprivation therapy and intensity‐modulated radiation therapy with gold marker implantation for intermediate‐risk and high‐risk prostate cancer

“…16,17,29,30 Zelefsky et al compared the toxicity and outcomes of high-dose (86.4 Gy) radiotherapy delivered by IGRT with GM implantation versus non-IGRT. 17 The incidence of grade !2 GU toxicity was significantly lower in the IGRT group than in the non-IGRT group (10.4% vs 20%), and multivariate analysis showed that IGRT was associated with a decreased incidence of late GU toxicity.…”

Late Toxicity and Quality of Life

“…The finding that-independently of the used generic score-global HRQOL is mostly not significantly or relevantly affected by radiotherapy side effects also was reported by the majority of recent published prospective and/or longitudinal studies using 3D-CRT, IMRT, or brachytherapy (BT) alone or in combination with EBRT (Geinitz et al 2010;Goineau et al 2013;Huang et al 2010;Lips et al 2009;Pardo et al 2010;Roeloffzen et al 2010;Schaake et al 2013), even after dose escalation (Goineau et al 2013;Lips et al 2009;Marchand et al 2010), when comparing baseline global HRQOL scales with the changes during follow-up. Though some studies have the limitation of a short follow, there is a growing number of long-term studies.…”