Health-related quality-of-life changes due to high-dose-rate brachytherapy, low-dose-rate brachytherapy, or intensity-modulated radiation therapy for prostate cancer
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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Progress in Low Dose Rate Brachytherapy for Prostate Cancer
2020, Seminars in Radiation OncologyCitation Excerpt :Desai has initiated a functional anatomy SBRT approach, Poten-C, to directly address the poor sexual function outcomes with SBRT with dose restriction to nerves, a promising and necessary measure to determine whether competitive sexual preservation can be accomplished with extreme hypofractionation.51 In a direct comparison of LDR, HDR, and IMRT with patient reported outcomes, sexual dysfunction was significantly greater in the HDR cohort.52 The low alpha-beta theory is questionable because of genetic variation and the variance in biology coded in the Gleason Score.
Patient-reported outcomes after treatment for clinically localized prostate cancer: A systematic review and meta-analysis
2018, Cancer Treatment ReviewsCitation Excerpt :There is only one study of intensity modulated radiotherapy at longer term, but it was not included in the meta-analyses since an ad-hoc PRO instrument was applied [115]. We found fewer studies on brachytherapy, 11 exclusively evaluating low-dose-rate brachytherapy [32,51,61,74,76,77,79,82,83,87,94], 3 assessing high-dose-rate [25,32,88], and 1 study evaluating both techniques [81]. The meta-analyses included 6–9 studies at the 1st year of follow-up, and 1–2 studies at 4th and 5th year.
Prospective Phase 2 Trial of Permanent Seed Implantation Prostate Brachytherapy for Intermediate-Risk Localized Prostate Cancer: Efficacy, Toxicity, and Quality of Life Outcomes
2018, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :Results such as these that favor brachytherapy over prostatectomy have been reported numerous times (12, 13) and overall indicate the high therapeutic ratio and low cost of prostate brachytherapy relative to that of other treatment options (10, 11). However, some argue that LDR brachytherapy could be related to similar or higher decreases in patient-reported quality of life as in patients treated with prostatectomy, intensity-modulated radiation therapy, or high-dose-rate brachytherapy (41, 42). Nevertheless, the use of brachytherapy in the United States has been declining (19) in favor of active surveillance for those with low-risk disease and surgery for those with intermediate- or high-risk disease (18).
Brachytherapy in the Management of Prostate Cancer
2017, Surgical Oncology Clinics of North AmericaCitation Excerpt :The time course for development and resolution of urinary symptoms after brachytherapy differs based on the dose delivery rate used. Expectedly, patients treated with HDR or 103Pd brachytherapy tend to have an earlier peak in International Prostate Symptom Scores (3–6 weeks) than those treated with 125I (2–5 months), followed by a more rapid return to baseline urinary function.25,97–99 GI toxicities generally occur at a lower frequency after prostate brachytherapy than those reported in pre-IMRT EBRT series and primarily manifest themselves as increased bowel frequency in the acute phase.
Thyroid hormones, Iodine and Iodides, and Antithyroid Drugs
2016, Side Effects of Drugs AnnualCitation Excerpt :When patients were divided into four groups according to prostate volume (< 30 or ≥ 30 cc) and NADT use, urinary G2 + toxicity was most commonly observed in those patients with larger prostates who received NADT, and least in the patients with smaller prostates and no NADT. Strom and coworkers reported a comparative study on prostate cancer patients who were treated with either high-dose-rate (HDR) brachytherapy, low-dose-rate (LDR) brachytherapy, intensity-modulated radiation therapy (IMRT), and monotherapy to investigate the effect on their urinary, bowel, and sexual health-related quality-of-life (HRQOL) [27R]. Study was conducted between years 2002 and 2013 with median follow-up of 32 months.
Financial Disclosures: None.
Conflicts of Interest: None.