Hypofractionated radiation therapy may be an acceptable treatment for some patients with localized prostate cancer
Personalizing treatment decisions according to patient baseline status remains important to maintaining long-term quality of life
Long-term patient-reported outcomes indicate that for some men with localized prostate cancer, hypofractionated (HRT) intensity-modulated radiation therapy (IMRT) may be a reasonable treatment option and result in similar quality of life outcomes, when compared to conventional radiation therapy (CRT), according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 57th Annual Meeting.
Men diagnosed with prostate cancer have multiple treatment options. When determining which treatment option(s) will be best for each patient, careful consideration must be given to treatment-related side effects and long-term toxicity, because men diagnosed with prostate cancer typically often have a long life expectancy. Although the body of literature on long-term quality of life outcomes in patients treated for prostate cancer is growing, there had previously been no long-term prospective data on quality of life outcomes following HRT, which is given at a higher dose over a shorter period of time than CRT (which is typically given daily on a Monday through Friday schedule, over approximately eight weeks at 2 Gy per fraction.)
This prospective, phase III study was conducted from 2002 to 2006, 303 men with low- to high-risk prostate cancer received randomized treatment, consisting of either CRT at 76 Gy in 38 fractions at 2.0 Gy per fraction, or HRT at 70.2 Gy in 26 fractions at 2.7 Gy per fraction. Patient-reported outcomes (PROs) were gathered at a median follow-up of 69 months and compared using the Expanded Prostate Cancer Index Composite (EPIC) and International Prostate Symptom Score (IPSS) questionnaires; PRO scores were reported as mean at each time point. Changes from baseline (defined as score <1 month prior to initiation of RT) were compared between treatment arms. Generalized estimating equation models were used to assess the effect of treatment over time.
Results of this study found that PROs were not statistically different with long-term follow-up in patients receiving CRT or HRT for localized prostate cancer. Although EPIC scores indicated an initial decrease in quality of life scores in both groups, it subsequently improved. There were no apparent differences in long-term quality of life outcomes in terms of bowel, sexual, hormonal, or general health status when comparing the two arms. Patients receiving HRT initially appeared to have worse urinary incontinence three to four years after treatment, although this subsequently resolved.
As with any treatment modality, patient selection is a key factor to deliver effective care. When examining both treatment groups, their baseline quality of life was the strongest predictor of quality of life at 48 months. Patients who have poor baseline urinary functional status should be counselled regarding the potential impact that HRT may have on their long-term quality of life. “Our results, which demonstrate that delivery of hypofractionated radiation is feasible in a select group of individuals, are not surprising,” said Talha Shaikh, MD, lead author of the study and resident in the department of radiation oncology at Fox Chase Cancer Center. “Although physicians have often worried about delivering HRT to the prostate, advanced radiation techniques have made delivery of high dose conformal radiation with minimal toxicity increasingly attainable. In this era of Health Care Reform, reducing treatment time and cost while maintaining efficacy is intriguing.”
The abstract, “Long-term Patient Reported Outcomes From a Phase 3 Randomized Prospective Trial of Conventional Versus Hypofractionated IMRT Radiation Therapy for Localized Prostate Cancer” will be presented in detail during a scientific session at ASTRO’s 57th Annual Meeting at 7:45 a.m. Central time on Monday, October 19, 2015. To speak with Dr. Shaikh, please call Nancy Mayes in ASTRO’s Press Office at the Henry B. González Convention Center in San Antonio on October 18 – 21, 2015 at 210-258-8104 or 210-258-8105, or email firstname.lastname@example.org.
ASTRO’s 57th Annual Meeting, being held at the Henry B. González Convention Center in San Antonio, October 18-21, 2015, is the nation’s premier scientific meeting in radiation oncology. The 2015 Annual Meeting is expected to attract more than 11,000 attendees including oncologists from all disciplines, medical physicists, dosimetrists, radiation therapists, radiation oncology nurses and nurse practitioners, biologists, physician assistants, practice administrators, industry representatives and other health care professionals from around the world. Led by ASTRO President Bruce D. Minsky, MD, FASTRO, a radiation oncologist specializing in gastrointestinal cancers, Professor of Radiation Oncology, and the Frank T. McGraw Memorial Chair at The University of Texas MD Anderson Cancer Center, Houston, the theme of the 2015 Meeting is “Technology Meets Patient Care.” Dr. Minsky’s Presidential Symposium, “Multidisciplinary Management of Esophageal and Rectal Cancers,” will feature Leonard L. Gunderson, MD, MS, FASTRO, and Joel E. Tepper, MD, FASTRO, to highlight imaging, staging, genomics and data mining approaches, as well as the latest advances in esophageal and colorectal cancer treatment. ASTRO’s four-day scientific meeting includes presentation of more than 2,100 abstracts: five plenary papers, 351 oral presentations, 1,609 posters and 171 digital posters in more than 53 educational sessions and 26 scientific panels for 20 disease-site tracks. Three keynote speakers will address a range of topics including cancer biology in radiation oncology, the essential roles of a physician, and patient safety: Arul Chinnaiyan, MD, PhD, Professor and Director, Michigan Center for Translational Pathology; Francisco G. Cigarroa, MD, Past President and Chancellor, University of Texas; and Gerald B. Hickson, MD, Senior Vice President and Assistant Vice Chancellor, Vanderbilt University Medical Center.
Erin L. Boyle
ASTRO is the premier radiation oncology society in the world, with nearly 11,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals that specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals, International Journal of Radiation Oncology • Biology • Physics (www.redjournal.org), Practical Radiation Oncology (www.practicalradonc.org) and Advances in Radiation Oncology (www.advancesradonc.org); developed and maintains an extensive patient website, www.rtanswers.org; and created the Radiation Oncology Institute (www.roinstitute.org), a non-profit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment. To learn more about ASTRO, visit www.astro.org.