Publication date: Available online 27 June 2019
Source: Practical Radiation Oncology
Author(s): Carola Link, Patrick Honeck, Frank Lohr, Christian Bolenz, Joerg Schaefer, Markus Bohrer, Frank Anton Giordano, Frederik Wenz, Daniel Buergy
Abstract
Purpose
To evaluate patient-reported quality of life (HRQOL) and decision regret (DR-Surgery/DR-Radiotherapy) after radiotherapy to the prostatic bed (PBRT) with or without whole pelvic radiotherapy (WPRT).
Methods/Materials
Patients received 79.29 Gy (n=78; R1/detectable tumors) or 71.43 Gy (n=56; R0/undetectable tumors) equivalent dose in 2-Gy fractions (EQD-2). Out of 134 patients, 51 had received additional WPRT with 44 Gy.
Decision regret was reported using a 5-item instrument (best-/worst scores: 0-100); EORTC-QLQ-C30 and EORTC-QLQ-PR25 questionnaires were used for HRQOL evaluation.
Results
At a median follow-up of 53 months, 134 valid questionnaires were returned. Most patients had locally advanced, node-positive (T3-4/N0=54.5%; N1=17.2%) or high-risk tumors (27.6%). Mean DR-Surgery was 17.61 and not associated with positive margins, salvage strategy or radiotherapy regimen. Mean DR-Radiotherapy was 18.64 and better in patients who had PBRT compared to WPRT (p=0.034; 24.39 vs. 15.24). Patient-reported bowel- and urinary symptoms were worse after WPRT compared to PBRT (both p<0.05); general HRQOL was numerically but not significantly better after PBRT without WPRT (p=0.055). Subset analyses showed increased bowel- and urinary symptom scores after WPRT irrespective of high-/lower dose cohort (all p<0.05).
Conclusions
WPRT was associated with increased symptom burden and decision regret as compared to PBRT. It is uncertain if the results can be extrapolated to lower-dose (<70 Gy) regimens. Further research is required to evaluate if specific decision support tools or treatment modifications according to the individual risk situation may be beneficial in this setting.
No comments:
Post a Comment