Elsevier

Brachytherapy

Volume 14, Issue 6, November–December 2015, Pages 818-825
Brachytherapy

Health-related quality-of-life changes due to high-dose-rate brachytherapy, low-dose-rate brachytherapy, or intensity-modulated radiation therapy for prostate cancer

https://doi.org/10.1016/j.brachy.2015.08.012Get rights and content

Abstract

Purpose

To compare urinary, bowel, and sexual health-related quality-of-life (HRQOL) changes due to high-dose-rate (HDR) brachytherapy, low-dose-rate (LDR) brachytherapy, or intensity-modulated radiation therapy (IMRT) monotherapy for prostate cancer.

Methods and Materials

Between January 2002 and September 2013, 413 low-risk or favorable intermediate-risk prostate cancer patients were treated with HDR brachytherapy monotherapy to 2700–2800 cGy in two fractions (n = 85), iodine-125 LDR brachytherapy monotherapy to 14,500 cGy in one fraction (n = 249), or IMRT monotherapy to 7400–8100 cGy in 37–45 fractions (n = 79) without pelvic lymph node irradiation. No androgen deprivation therapy was given. Patients used an international prostate symptoms score questionnaire, an expanded prostate cancer index composite-26 bowel questionnaire, and a sexual health inventory for men questionnaire to assess their urinary, bowel, and sexual HRQOL, respectively, pretreatment and at 1, 3, 6, 9, 12, and 18 months posttreatment.

Results

Median follow-up was 32 months. HDR brachytherapy and IMRT patients had significantly less deterioration in their urinary HRQOL than LDR brachytherapy patients at 1 and 3 months after irradiation. The only significant decrease in bowel HRQOL between the groups was seen 18 months after treatment, at which point IMRT patients had a slight, but significant, deterioration in their bowel HRQOL compared with HDR and LDR brachytherapy patients. HDR brachytherapy patients had worse sexual HRQOL than both LDR brachytherapy and IMRT patients after treatment.

Conclusions

IMRT and HDR brachytherapy cause less severe acute worsening of urinary HRQOL than LDR brachytherapy. However, IMRT causes a slight, but significant, worsening of bowel HRQOL compared with HDR and LDR brachytherapy.

Introduction

Treatment options for low-risk and favorable intermediate-risk prostate cancer patients who have a life expectancy of at least 10 years include radical prostatectomy (1), high-dose-rate (HDR) brachytherapy [2], [3], [4], low-dose-rate (LDR) brachytherapy [5], [6], or external beam radiation therapy (EBRT) [7], [8], [9], [10].

Brachytherapy provides comparable outcomes and is more cost-effective than EBRT [11], [12]. Also, brachytherapy offers a potential radiobiological benefit over conventionally fractionated EBRT by delivering hypofractionated treatment, which may increase the sensitivity of prostate cancer to radiation therapy by favorably affecting the α/β ratio [3], [13], [14]. Because cure rates are similar between treatment options (15), health-related quality of life (HRQOL) is an important factor in a prostate cancer patient's decision-making process (16).

Physician-assessed HRQOL changes do not correlate with patient-assessed changes. Physicians underestimate worsening in symptoms and overestimate improvement in symptoms relative to patients (17). As a result, it is important to measure patient-assessed HRQOL.

Studies have demonstrated different HRQOL with HDR brachytherapy, LDR brachytherapy, and EBRT [16], [18]. As a result, we assessed urinary, bowel, and sexual HRQOL with HDR brachytherapy, LDR brachytherapy, and intensity-modulated radiation therapy (IMRT).

Section snippets

Patient characteristics

After obtaining investigational review board approval, the records of 1294 men with clinically localized prostate cancer who underwent HDR brachytherapy, iodine (I)-125 LDR brachytherapy, or IMRT between January 2002 and September 2013 were reviewed. Patients were excluded if they had unfavorable intermediate-risk [19], [20] or high-risk (21) prostate cancer, or if they were treated with androgen deprivation therapy (ADT) [22], [23], combined IMRT and HDR brachytherapy or LDR brachytherapy,

Results

Median follow-up was 32 months. Sixty percent of IPSS, EPIC-26, and SHIM questionnaires were completed by all patients pretreatment and at 1, 3, 6, 9, 12, and 18 months after irradiation. Only patients who completed pretreatment questionnaires were included. Forty-nine of eighty-five (58%) HDR brachytherapy patients, 149 of 249 (60%) LDR brachytherapy patients, and 49 of 79 (62%) IMRT patients completed questionnaires before and after treatment. Patient compliance with questionnaire completion

Discussion

In this study, 60% of prostate cancer patients completed all three HRQOL questionnaires pretreatment and at 1, 3, 6, 9, 12, and 18 months after irradiation. Similarly, others have reported 36–78% compliance rates with completion of HRQOL questionnaires [31], [32].

This is the first study to compare HRQOL changes in prostate cancer patients who underwent HDR brachytherapy, LDR brachytherapy, or IMRT. Two previous studies reported HRQOL in prostate cancer patients treated with radical

Conclusion

IMRT and HDR brachytherapy caused less severe acute worsening of urinary HRQOL than LDR brachytherapy in prostate cancer patients. However, at 18 months posttreatment, IMRT caused a slight, but significant, worsening of bowel HRQOL compared with HDR and LDR brachytherapy. This finding may have been due, in part, to the older age of the IMRT patients. HDR brachytherapy was associated with worse sexual HRQOL. This observation may have been due to less frequent use of PDE inhibitors along with the

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    Financial Disclosures: None.

    Conflicts of Interest: None.

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