External beam radiotherapy of prostate cancer with or without high dose-rate brachytherapy: the Norwegian experience with long-term urinary and bowel adverse effects
DOI:
https://doi.org/10.2340/sju.v58.9571Keywords:
Brachytherapy, prostate cancer, patient-report outcomes, adverse effects, epic-26, QoLAbstract
Background: There are few studies utilizing the Expanded Prostate Index Composite questionnaire-26 (EPIC-26) questionnaire to examine the long-term association between Domain Summary Scores (DSSs) and Quality of Life (QoL) after External Beam Radiation Therapy (EBRT, 3DCRT [3D conventional radiotherapy]/IMRT [intensity modulated radiation therapy]) versus EBRT combined with High-Dose-Rate Brachytherapy (BT+, 3DCRT [3D conventional radiotherapy]/IMRT). In this cross-sectional study we compare long-term adverse effects and QoL after BT+ with EBRT.
Methods: Prostate Cancer Survivors who at least 5 years previously, had undergone BT+ at Oslo University Hospital between 2004 and 2010 (n = 259) or EBRT (multicentre cohort) between 2009 and 2010 (n = 99) completed a questionnaire containing EPIC-26, Short Form-12 and questions regarding comorbidity/social status. Results were presented as DSSs and Physical/Mental Composite Scores of QoL (PCS/MCS). Regression analyses explored firstly the associations between treatment modality and DSSs and secondly the impact of DSSs on QoL. We estimated the proportions of patients with big/moderate problems. Clinical relevance was set according to the lowest limit of published Minimal Important Differences. P-values <0.05 were considered statistically significant.
Results: In multivariate analysis, only the urinary incontinence DSS remained statistically (P < 0.05) and clinically significantly greater after BT+ than EBRT (90 vs. 83). The number of men with moderate/big urinary or bowel problems was halved after BT+ (P < 0.05). The number of patients with impaired PCS (score < 45) were lower in the BT+ group than the EBRT group (P = 0.02). Regression analysis showed that decreasing levels of bowel and urinary irritation/obstructive DSSs predicted worsening of PCS (P < 0.001) and MCS (P = 0.007), respectively.
Conclusions: Dose-escalated radiotherapy by BT did not negatively impact long-term adverse effects, substantial problems or QoL compared with EBRT. Future randomised studies using improved EBRT techniques are needed.
Downloads
References
Aus G, Abbou CC, Bolla M, Heidenreich A, Schmid HP, van Poppel H, et al. EAU guidelines on prostate cancer. Eur Urol. 2005;48(4):546–51. doi: 10.1016/j.eururo.2005.06.001 DOI: https://doi.org/10.1016/j.eururo.2005.06.001
Hoskin PJ, Rojas AM, Bownes PJ, Lowe GJ, Ostler PJ, Bryant L. Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer. Radiother Oncol. 2012;103(2):217–22. doi: 10.1016/j.radonc.2012.01.007 DOI: https://doi.org/10.1016/j.radonc.2012.01.007
Kishan AU, Cook RR, Ciezki JP, Ross AE, Pomerantz MM, Nguyen PL, et al. Radical prostatectomy, external beam radiotherapy, or external beam radiotherapy with brachytherapy boost and disease progression and mortality in patients with gleason score 9–10 prostate cancer. JAMA. 2018;319(9):896–905. doi: 10.1001/jama.2018.0587 DOI: https://doi.org/10.1001/jama.2018.0587
Mottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021;79(2):243–62. doi: 10.1016/j.eururo.2020.09.042 DOI: https://doi.org/10.1016/j.eururo.2020.09.042
Aas K, Berge V, Myklebust T, Fosså SD. Comparative survival outcomes of high-risk prostate cancer treated with radical prostatectomy or definitive radiotherapy regimens. Eur Urol Open Sci. 2021;26:55–63. doi: 10.1016/j.euros.2021.01.011 DOI: https://doi.org/10.1016/j.euros.2021.01.011
Wedde TB, Smaastuen MC, Brabrand S, Fosså SD, Kaasa S, Tafjord G, et al. Ten-year survival after high-dose-rate brachytherapy combined with external beam radiation therapy in high-risk prostate cancer: a comparison with the Norwegian SPCG-7 cohort. Radiother Oncol. 2019;132:211–17. doi: 10.1016/j.radonc.2018.10.013 DOI: https://doi.org/10.1016/j.radonc.2018.10.013
Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2016;375(15):1425–37. doi: 10.1056/NEJMoa1606221 DOI: https://doi.org/10.1056/NEJMoa1606221
Dearnaley D, Griffin CL, Lewis R, Mayles P, Mayles H, Naismith OF, et al. Toxicity and patient-reported outcomes of a phase 2 randomized trial of prostate and pelvic lymph node versus prostate only radiotherapy in advanced localised prostate cancer (PIVOTAL). Int J Radiat Oncol Biol Phys. 2019;103(3):605–17. doi: 10.1016/j.ijrobp.2018.10.003 DOI: https://doi.org/10.1016/j.ijrobp.2018.10.003
Catton CN, Lukka H, Gu CS, Martin JM, Supiot S, Chung PWM, et al. Randomized trial of a hypofractionated radiation regimen for the treatment of localized prostate cancer. J Clin Oncol. 2017;35(17):1884–90. doi: 10.1200/JCO.2016.71.7397 DOI: https://doi.org/10.1200/JCO.2016.71.7397
Mohammed N, Kestin L, Ghilezan M, Krauss D, Vicini F, Brabbins D, et al. Comparison of acute and late toxicities for three modern high-dose radiation treatment techniques for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2012;82(1):204–12. doi: 10.1016/j.ijrobp.2010.10.009 DOI: https://doi.org/10.1016/j.ijrobp.2010.10.009
D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280(11):969–74. doi: 10.1001/jama.280.11.969 DOI: https://doi.org/10.1001/jama.280.11.969
Lilleby W, Tafjord G, Raabe NK. Implementation of high-dose-rate brachytherapy and androgen deprivation in patients with prostate cancer. Int J Radiat Oncol Biol Phys. 2012;83(3):933–9. doi: 10.1016/j.ijrobp.2011.08.028 DOI: https://doi.org/10.1016/j.ijrobp.2011.08.028
Steinsvik EA, Axcrona K, Dahl AA, Eri LM, Stensvold A, Fosså SD. Can sexual bother after radical prostatectomy be predicted preoperatively? Findings from a prospective national study of the relation between sexual function, activity and bother. BJU Int. 2012;109(9):1366–74. doi: 10.1111/j.1464-410X.2011.10598.x DOI: https://doi.org/10.1111/j.1464-410X.2011.10598.x
Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, et al. EAU guidelines on prostate cancer. Eur Urol. 2008;53(1):68–80. doi: 10.1016/j.eururo.2007.09.002 DOI: https://doi.org/10.1016/j.eururo.2007.09.002
Fosså SD, Storås AH, Steinsvik EA, Myklebust TA, Eri LM, Loge JH, et al. Psychometric testing of the Norwegian version of the Expanded Prostate Cancer Index Composite 26-item version (EPIC-26). Scand J Urol. 2016;50(4):280–5. doi: 10.3109/21681805.2016.1163617 DOI: https://doi.org/10.3109/21681805.2016.1163617
Ware J, Jr., Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33. doi: 10.1097/00005650-199603000-00003 DOI: https://doi.org/10.1097/00005650-199603000-00003
Michigan M. Expanded prostate cancer index composite, Michigan Medicine urology. 2020. Available from: https://medicine.umich.edu/dept/urology/research/epic [cited 1 January 2022].
Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, et al. Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: results from the IQOLA project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51(11):1171–8. doi: 10.1016/S0895-4356(98)00109-7 DOI: https://doi.org/10.1016/S0895-4356(98)00109-7
Osoba D, Rodrigues G, Myles J, Zee B, Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16(1):139–44. doi: 10.1200/JCO.1998.16.1.139 DOI: https://doi.org/10.1200/JCO.1998.16.1.139
Skolarus TA, Dunn RL, Sanda MG, Chang P, Greenfield TK, Litwin MS, et al. Minimally important difference for the expanded prostate cancer index composite short form. Urology. 2015;85(1):101–5. doi: 10.1016/j.urology.2014.08.044 DOI: https://doi.org/10.1016/j.urology.2014.08.044
Stata. Stata 15.1. 2020. Available from: https://www.stata.com/stata15/ [cited 1 October 2021].
SPSS. IBM SPSS statistics. 2022. Available from: https://www.ibm.com/ibm-spss-statistics-25s [cited 1 October 2022].
Martínez E, Garin O, Pardo Y, Fernández P, Guix B, Gutiérrez C, et al. Five-year quality of life in patients with high-risk localized prostate cancer treated with external beam radiotherapy alone versus external beam radiotherapy with high-dose-rate brachytherapy boost: a prospective multicenter study. J Contemp Brachyther. 2021;13(1):1–11. doi: 10.5114/jcb.2021.103580 DOI: https://doi.org/10.5114/jcb.2021.103580
Parry MG, Nossiter J, Cowling TE, Sujenthiran A, Berry B, Cathcart P, et al. Patient-reported functional outcomes following external beam radiation therapy for prostate cancer with and without a high-dose rate brachytherapy boost: a national population-based study. Radiother Oncol. 2021;155:48–55. doi: 10.1016/j.radonc.2020.10.019 DOI: https://doi.org/10.1016/j.radonc.2020.10.019
Freiberger C, Berneking V, Vögeli TA, Kirschner-Hermanns R, Eble MJ, Pinkawa M. Quality of life up to 10 years after external beam radiotherapy and/or brachytherapy for prostate cancer. Brachytherapy. 2018;17(3):517–23. doi: 10.1016/j.brachy.2018.01.008 DOI: https://doi.org/10.1016/j.brachy.2018.01.008
Zelefsky MJ, Fuks Z, Happersett L, Lee HJ, Ling CC, Burman CM, et al. Clinical experience with intensity modulated radiation therapy (IMRT) in prostate cancer. Radiother Oncol. 2000;55(3):241–9. doi: 10.1016/S0167-8140(99)00100-0 DOI: https://doi.org/10.1016/S0167-8140(99)00100-0
Michalski JM, Yan Y, Watkins-Bruner D, Bosch WR, Winter K, Galvin JM, et al. Preliminary toxicity analysis of 3-dimensional conformal radiation therapy versus intensity modulated radiation therapy on the high-dose arm of the Radiation Therapy Oncology Group 0126 prostate cancer trial. Int J Radiat Oncol Biol Phys. 2013;87(5):932–8. doi: 10.1016/j.ijrobp.2013.07.041 DOI: https://doi.org/10.1016/j.ijrobp.2013.07.041
Fosså SD, Dahl AA. Global quality of life after curative treatment for prostate cancer: what matters? A study among members of the Norwegian Prostate Cancer Patient Association. Clin Genitourin Cancer. 2015;13(6):518–24. doi: 10.1016/j.clgc.2015.07.004 DOI: https://doi.org/10.1016/j.clgc.2015.07.004
Sonn GA, Sadetsky N, Presti JC, Litwin MS.Differing perceptions of quality of life in patients with prostate cancer and their doctors. J Urol. 2013;189(1 Suppl.):S59–65; discussion S. doi: 10.1016/j.juro.2012.11.032 DOI: https://doi.org/10.1016/j.juro.2012.11.032
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Trude B. Wedde, Milada C. Smaastuen, Kari Vatne, Melanie Birthe Schulz-Jaavall, Sophie D. Fosså, Wolfgang LH. Lilleby
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
