Jens Klotz

Dose-escalation using intensity-modulated radiotherapy for prostate cancer – Evaluation of the dose distribution with and without 18F-choline PET-CT detected simultaneous integrated boost

BACKGROUND AND PURPOSE The aim of the study was to evaluate the impact of a dose escalation to an (18)F-choline PET-CT defined simultaneous integrated boost (IB) on the dose distribution and changes of the equivalent uniform dose (EUD). MATERIALS AND METHODS PET-CT was performed in 12 consecutive patients for treatment planning. An intraprostatic lesion was defined by a tumour-to-background uptake value ratio >2 (GTV(PET)). Dose escalation was focused only on the intraprostatic lesion. Two comparisons were evaluated: whole prostate irradiation to 76 Gy+/-boost to 80 Gy (C1) and whole prostate irradiation to 66.6 Gy+/-boost to 83.25 Gy (C2). RESULTS PTV/GTV(PET)+margins were covered by a mean EUD of 75.9/76.1 Gy vs. 77.1/80.1 Gy (C1) and 66.5/66.2 Gy vs. 71.1/82.9 Gy (C2) (p<0.01, respectively). Concerning the organs at risk, EUD increased slightly with an additional boost (mean EUD for bladder: C1 53.2 Gy vs. 53.8 Gy; C2 43.0 Gy vs. 45.1 Gy; for rectum: C1 52.0 Gy vs. 52.6 Gy; C2 43.0 Gy vs. 45.4 Gy; p<0.01, respectively). The distance to the organs at risk had a significant impact on the respective maximum doses in the treatment plans with IB. CONCLUSIONS Treatment planning with IB allows an individually adapted dose escalation. The therapeutic ratio can be improved by a considerable dose escalation to the macroscopic tumour, but only minor EUD changes to the bladder and rectum.

Erectile Dysfunction After External Beam Radiotherapy for Prostate Cancer

BACKGROUND There is a lack of prospective studies focusing on the sexual quality of life of prostate cancer patients after conformal radiotherapy (RT). OBJECTIVE To evaluate the incidence, progression, and predictive factors for erectile dysfunction (ED). DESIGN, SETTING AND PARTICIPANTS Patients who responded to the sexual domain of the Expanded Prostate Cancer Index Composite (EPIC) questionnaire before and more than 1 yr after RT and never received an antiandrogen treatment were included (n=123). INTERVENTION RT dose was 70.2-72 Gy. Eleven patients used a phosphodiesterase-5 (PDE-5) inhibitor. MEASUREMENTS Patients responded to the EPIC questionnaire before (time A), at the last day (B), a median time of 2 mo after (C), and 16 mo after (D) RT. In a multivariate analysis, risk factors (patient age, prostate volume, planning target volume, use of PDE-5 inhibitor, comorbidities) were tested for their independent effects on ED before and after RT. RESULTS AND LIMITATIONS Sexual function and bother scores had already decreased by the end of RT (median function and bother scores at times A/B/C/D: 41/30/32/24 and 75/50/50/50). Initial function scores correlated well with late function scores (r=0.7; p<0.001). The ability to have an erection was reported by 81%/72%/74%/60% (preserved erectile ability in 70% at time D), erections firm enough for sexual intercourse by 44%/33%/35%/27% (preserved erections sufficient for intercourse in 53% at time D) of patients. A higher patient age and diabetes were predictive of both a pre-existing ED and a post-RT acquired ED. Nightly erections before treatment proved prognostically favourable (at least weekly vs. < weekly-hazard ratio of 5.9 for preserved erections sufficient for intercourse; p=0.01). Higher rates of ED can be expected with longer follow-up. CONCLUSIONS The incidence of ED progressively increases after RT. Patient age and diabetes are risk factors for both pre-treatment and RT-associated ED. Nightly erections before RT proved prognostically favourable.

Image-guided radiotherapy for prostate cancer

PurposeTo evaluate inter- and intrafraction organ motion with an ultrasound-based prostate localization system (BAT®) for patients treated with intensity-modulated radiotherapy for prostate cancer.Patients and MethodsAfter set-up to external skin marks, 260/219 ultrasound-based alignments were performed before/after irradiation in 32 consecutive patients. Image quality was classified as good, satisfactory or poor. Patient- and imaging-related parameters were analyzed to identify predictors for poor image quality. Shifts in relation to the treatment planning computed tomography (CT) were recorded before/after irradiation in the superior-inferior (SI), anterior-posterior (AP) and right-left (RL) directions to determine inter-/intrafraction prostate motion.ResultsThe thickness of tissue anterior to the bladder and bladder volume during the ultrasound localization as well as an inferior prostate position relative to public symphysis (determined in treatment planning CT) were found to be independent predictors of a poor image quality. Interfraction shifts (mean ± standard deviation: −0.2 ± 4.8 [SI], 2.4 ± 6.6 [AP] and 1.9 ± 4.6 [RL]) varied much stronger than intrafraction shifts (0.0 ± 2.0 [SI], 0.6 ± 2.2 [AP] and 0.2 ± 1.9 [RL]). A larger pressure of the ultrasound probe (determined as a larger reduction of the distance abdominal skin to prostate between the planning CT and the ultrasound) was applied in case of poor image quality, associated with larger systematic posterior prostate displacements.ConclusionIntrafraction prostate shifts are considerably smaller in comparison to interfraction shifts. Bladder filling and a small pressure on the ultrasound probe are crucial to achieve an adequate image quality without systematic prostate displacements.ZusammenfassungZielBestimmung der inter- und intrafraktionellen Organbewegung mit einem ultraschallbasierten Lokalisationssystem der Prostata (BAT®) bei mit intensitätsmodulierter Radiotherapie behandelten Patienten mit Prostatakarzinom.Patienten und MethodikNach Lagerung entsprechend der externen Hautmarkierung wurden 260/219 ultraschallbasierte Positionierungen vor/nach Bestrahlung bei 32 konsekutiven Patienten durchgeführt. Die Bildqualität wurde als gut, zufriedenstellend oder schlecht bewertet. Patienten- und bildgebungsabhängige Parameter wurden zur Identifikation von Prädiktoren für schlechte Bildqualität analysiert. Verschiebungen im Verhältnis zur Bestrahlungsplanungs-Computertomographie(-CT) wurden in der superior-inferioren (SI), anterior-posterioren (AP) und Rechts-links-(RL-)Achse vor/nach Bestrahlung dokumentiert, um inter-/intrafraktionelle Prostatabewegungen zu bestimmen.ErgebnisseSowohl die Dicke des Gewebes ventral der Blase und das Blasenvolumen während der Ultraschalllokalisation als auch eine inferiore Prostatalage relativ zur Symphyse (bestimmt im Bestrahlungsplanungs-CT) fanden sich als unabhängige Prädiktoren einer schlechten Bildqualität. Interfraktionelle Verschiebungen (Mittelwert ± Standardabweichung: −0,2 ± 4,8 [SI], 2,4 ± 6,6 [AP] und 1,9 ± 4,6 [RL]) variierten viel stärker als intrafraktionelle Verschiebungen (0,0 ± 2,0 [SI], 0,6 ± 2,2 [AP] und 0,2 ± 1,9 [RL]). Ein stärkerer Druck auf die Ultraschallsonde (als eine größere Reduktion des Abstandes Bauchhaut zu Prostata zwischen dem Planungs-CT und dem Ultraschall bestimmt) wurde vor allem bei schlechter Bildqualität ausgeübt, verbunden mit größeren systematischen dorsalen Prostataverschiebungen.SchlussfolgerungIntrafraktionelle Prostataverschiebungen sind deutlich geringer als interfraktionelle Verschiebungen. Blasenfüllung und ein geringer Druck auf die Ultraschallsonde sind zum Erzielen einer adäquaten Bildqualität ohne systematische Prostataverschiebungen entscheidend.

Dose-escalation using intensity-modulated radiotherapy for prostate cancer - evaluation of quality of life with and without 18 F-choline PET-CT detected simultaneous integrated boost

BackgroundIn comparison to the conventional whole-prostate dose escalation, an integrated boost to the macroscopic malignant lesion might potentially improve tumor control rates without increasing toxicity. Quality of life after radiotherapy (RT) with vs. without 18F-choline PET-CT detected simultaneous integrated boost (SIB) was prospectively evaluated in this study.MethodsWhole body image acquisition in supine patient position followed 1 h after injection of 178-355MBq 18F-choline. SIB was defined by a tumor-to-background uptake value ratio > 2 (GTVPET). A dose of 76Gy was prescribed to the prostate (PTVprostate) in 2Gy fractions, with or without SIB up to 80Gy. Patients treated with (n = 46) vs. without (n = 21) SIB were surveyed prospectively before (A), at the last day of RT (B) and a median time of two (C) and 19 month (D) after RT to compare QoL changes applying a validated questionnaire (EPIC - expanded prostate cancer index composite).ResultsWith a median cut-off standard uptake value (SUV) of 3, a median GTVPET of 4.0 cm3 and PTVboost (GTVPET with margins) of 17.3 cm3 was defined. No significant differences were found for patients treated with vs. without SIB regarding urinary and bowel QoL changes at times B, C and D (mean differences ≤3 points for all comparisons). Significantly decreasing acute urinary and bowel score changes (mean changes > 5 points in comparison to baseline level at time A) were found for patients with and without SIB. However, long-term urinary and bowel QoL (time D) did not differ relative to baseline levels - with mean urinary and bowel function score changes < 3 points in both groups (median changes = 0 points). Only sexual function scores decreased significantly (> 5 points) at time D.ConclusionsTreatment planning with 18F-choline PET-CT allows a dose escalation to a macroscopic intraprostatic lesion without significantly increasing toxicity.

Combination of Dose Escalation with Technological Advances (Intensity-Modulated and Image-Guided Radiotherapy) Is Not Associated with Increased Morbidity for Patients with Prostate Cancer

Purpose:The aim was to evaluate treatment-related morbidity after intensity-modulated (IMRT) and image-guided (IGRT) radiotherapy with a total dose of 76 Gy in comparison to conventional conformal radiotherapy (3DCRT) up to 70.2–72 Gy for patients with prostate cancer.Patients and Methods:All patients were prospectively surveyed prior to, on the last day, as well as after a median time of 2 and 16 months after RT using a validated questionnaire (Expanded Prostate Cancer Index Composite). Criteria for the 78 matched pairs after IMRT vs. 3DCRT were patient age, use of antiandrogens, treatment volume (± whole pelvis), prognostic risk group, and urinary/bowel/sexual quality of life (QoL) before treatment.Results:QoL changes after dose-escalated IMRT were found to be similar to QoL changes after 3DCRT in all domains. Only sexual function scores more than 1 year after RT decreased slightly more after 3DCRT in comparison to IMRT (mean 9 vs. 6 points; p = 0.04), with erections firm enough for intercourse in 14% vs. 30% (p = 0.03). Painful bowel movements were reported more frequently after 3DCRT vs. IMRT 2 months after treatment (≥ once a day in 10% vs. 1%; p = 0.03), but a tendency for higher rectal bleeding rates was found after IMRT vs. 3DCRT more than 1 year after RT (≥ rarely in 20% vs. 9%; p = 0.06).Conclusion:Combination of dose escalation with technological advances (IMRT and IGRT) is not associated with increased morbidity for patients with prostate cancer.ZusammenfassungZiel:Ziel war die Analyse therapiebedingter Morbidität nach intensitätsmodulierter (IMRT) und bildgeführter (IGRT) Radiotherapie mit einer Gesamtdosis von 76 Gy im Vergleich zur konventionellen konformalen Radiotherapie (3DCRT) bis 70,2–72 Gy bei Patienten mit einem Prostatakarzinom.Patienten und Methoden:Alle Patienten wurden prospektiv vor Beginn, am letzten Tag, median 2 Monate und 16 Monate nach RT mittels eines validierten Fragebogens befragt (Expanded Prostate Cancer Index Composite). Kriterien für 78 gematchte Paare nach IMRT vs. 3DCRT waren das Patientenalter, der Einsatz eines Antiandrogens, Zielvolumen (± Becken), prognostische Risikogruppe und Lebensqualität (LQ) beim Wasserlassen/Stuhlgang/Sexualität vor der Behandlung.Ergebnisse:LQ-Veränderungen nach dosiseskalierter IMRT waren den LQ-Veränderungen nach 3DCRT in allen Domänen sehr ähnlich. Nur der Punktwert für die sexuelle Funktion fiel über ein Jahr nach der Behandlung nach 3DCRT etwas mehr als nach IMRT (durchschnittlich 9 vs. 6 Punkte; p = 0,04), mit ausreichender Erektion für Geschlechtsverkehr in 14% vs. 30% (p = 0,03). Schmerzhafter Stuhlgang wurde zwei Monate nach Therapie häufiger nach 3DCRT als nach IMRT berichtet (≥ 1-mal täglich in 10% vs. 1%; p = 0,03); jedoch fand sich über ein Jahr nach RT die Tendenz zu einer häufigeren Rate rektaler Blutungen nach IMRT als nach 3DCRT (≥ selten in 20% vs. 9%; p = 0,06).Schlussfolgerung:Die Verknüpfung einer Dosiseskalation mit technologischen Fortschritten (IMRT und IGRT) ist bei Patienten mit einem Prostatakarzinom nicht mit erhöhter Morbidität assoziiert.

Spacer stability and prostate position variability during radiotherapy for prostate cancer applying a hydrogel to protect the rectal wall.

BACKGROUND AND PURPOSE The aim was to evaluate the spacer dimensions and prostate position variability during the course of radiotherapy for prostate cancer. MATERIALS AND METHODS CT scans were performed in a group of 15 patients (G1) after the 10 ml injection of a hydrogel spacer (SpaceOAR™) and 30 patients without a spacer (G2) before the beginning of treatment (CT1) and in the last treatment week, 10-12 weeks following spacer implantation (CT2). Spacer dimensions and displacements were determined and prostate displacements compared. RESULTS Mean volume of the hydrogel increased slightly (17%; p<0.01), in 4 of 15 patients >2 cm(3). The average displacement of the hydrogel center of mass was 0.6mm (87%≤ 2.2mm), -0.6mm (100% ≤ 2.2mm) and 1.4mm (87% ≤ 4.3mm) in the x-, y- and z-axes (not significant). The average distance between prostate and anterior rectal wall before/at the end of radiotherapy was 1.6 cm/1.5 cm, 1.2 cm/1.3 cm and 1.0 cm/1.1cm at the level of the base, middle and apex (G1). Prostate position variations were similar comparing G1 and G2, but significant systematic posterior displacements were only found in G2. CONCLUSIONS A stable distance between the prostate and anterior rectal wall results during the radiotherapy course after injection of the spacer before treatment planning. Larger posterior prostate displacements could be reduced.

Intensity-modulated radiotherapy for prostate cancer implementing molecular imaging with 18F-choline PET-CT to define a simultaneous integrated boost.

Purpose:To report the own experience with 66 patients who received 18F-choline PET-CT (positron emission tomography-computed tomography) for treatment planning.Patients and Methods:Image acquisition followed 1 h after injection of 178–355 MBq 18F-choline. An intraprostatic lesion (GTVPET [gross tumor volume]) was defined by a tumor-to-background SUV (standard uptake value) ratio > 2. A dose of 76 Gy was prescribed to the prostate in 2-Gy fractions, with a simultaneous integrated boost up to 80 Gy.Results:A boost volume could not be defined for a single patient. One, two and three or more lesions were found for 36 (55%), 22 (33%) and seven patients (11%). The lobe(s) with a positive biopsy correlated with a GTVPET in the same lobe in 63 cases (97%). GTVPET was additionally defined in 33 of 41 prostate lobes (80%) with only negative biopsies. GTVPET, SUVmean and SUVmax were found to be dependent on well-known prognostic risk factors, particularly T-stage and Gleason Score. In multivariate analysis, Gleason Score > 7 resulted as an independent factor for GTVPET > 8 cm3 (hazard ratio 5.5; p = 0.02) and SUVmax > 5 (hazard ratio 4.4; p = 0.04). Neoadjuvant hormonal treatment (NHT) did not affect SUV levels. The mean EUDs (equivalent uniform doses) to the rectum and bladder (55.9 Gy and 54.8 Gy) were comparable to patients (n = 18) who were treated in the same period without a boost (54.3 Gy and 55.6 Gy).Conclusion:Treatment planning with 18F-choline PET-CT allows the definition of an integrated boost in nearly all prostate cancer patients – including patients after NHT – without considerably affecting EUDs for the organs at risk. GTVPET and SUV levels were found to be dependent on prognostic risk factors, particularly Gleason Score.ZusammenfassungZiel:Erfahrungsbericht mit 66 Patienten nach 18F-Cholin-PET-CT (Positronenemissionstompgraphie-Computertomographie) zur Bestrahlungsplanung.Patienten und Methodik:Die Bildakquisition erfolgte 1 h nach Injektion von 178–355 MBq 18F-Cholin. Ein intraprostatischer Herd (GTVPET [makroskopisches Tumorvolumen]) wurde ab einem Tumor-zu-Hintergrund-SUV-(„standard uptake value“-)Quotienten > 2 definiert. Die Verschreibungsdosis für die Prostata betrug 76 Gy in 2-Gy-Einzeldosen mit simultanem integrierten Boost bis 80 Gy.Ergebnisse:Ein Boostvolumen konnte bei einem Patienten nicht definiert werden. Ein, zwei und drei oder mehr Herde wurden bei 36 (55 %), 22 (33 %) und sieben Patienten (11 %) gefunden. Der/die Lappen mit positiver Biopsie korrelierte/n in 63 Fallen (97 %)mit dem GTVPET im gleichen Lappen. Zusätzlich wurde ein GTVPET in 33 von 41 Lappen (80 %) mit nur negativen Biopsien definiert. GTVPET, SUVmean und SUVmax zeigten eine Abhängigkeit von bekannten Risikofaktoren, insbesondere T-Stadium und Gleason-Score. In multivariater Analyse resultierte ein Gleason-Score > 7 als ein unabhängiger Faktor für GTVPET > 8 cm3 (relatives Risiko 5,5; p = 0,02) und SUVmax > 5 (relatives Risiko 4,4; p = 0,04). Eine neoadjuvante Hormontherapie (NHT) war ohne Einfluss auf SUV-Werte. Die mittleren EUDs („equivalent uniform doses“) für Rektum und Blase (55,9 Gy und 54,8 Gy) waren vergleichbar zu Patienten (n = 18), die in der gleichen Periode ohne Boost bestrahlt wurden (54,3 Gy und 55,6 Gy).Schlussfolgerung:Die Bestrahlungsplanung nach 18F-Cholin-PET-CT ermöglicht die Definition eines integrierten Boostvolumens bei nahezu allen Patienten mit Prostatakarzinom – einschließlich Patienten nach NHT – ohne einen relevanten Einfluss auf die EUDs für die Risikoorgane. GTVPET- und SUV-Werte zeigten eine Abhängigkeit von prognostischen Risikofaktoren, insbesondere dem Gleason-Score.

Image-guided radiotherapy for prostate cancer. Implementation of ultrasound-based prostate localization for the analysis of inter- and intrafraction organ motion.

PurposeTo evaluate inter- and intrafraction organ motion with an ultrasound-based prostate localization system (BAT®) for patients treated with intensity-modulated radiotherapy for prostate cancer.Patients and MethodsAfter set-up to external skin marks, 260/219 ultrasound-based alignments were performed before/after irradiation in 32 consecutive patients. Image quality was classified as good, satisfactory or poor. Patient- and imaging-related parameters were analyzed to identify predictors for poor image quality. Shifts in relation to the treatment planning computed tomography (CT) were recorded before/after irradiation in the superior-inferior (SI), anterior-posterior (AP) and right-left (RL) directions to determine inter-/intrafraction prostate motion.ResultsThe thickness of tissue anterior to the bladder and bladder volume during the ultrasound localization as well as an inferior prostate position relative to public symphysis (determined in treatment planning CT) were found to be independent predictors of a poor image quality. Interfraction shifts (mean ± standard deviation: −0.2 ± 4.8 [SI], 2.4 ± 6.6 [AP] and 1.9 ± 4.6 [RL]) varied much stronger than intrafraction shifts (0.0 ± 2.0 [SI], 0.6 ± 2.2 [AP] and 0.2 ± 1.9 [RL]). A larger pressure of the ultrasound probe (determined as a larger reduction of the distance abdominal skin to prostate between the planning CT and the ultrasound) was applied in case of poor image quality, associated with larger systematic posterior prostate displacements.ConclusionIntrafraction prostate shifts are considerably smaller in comparison to interfraction shifts. Bladder filling and a small pressure on the ultrasound probe are crucial to achieve an adequate image quality without systematic prostate displacements.ZusammenfassungZielBestimmung der inter- und intrafraktionellen Organbewegung mit einem ultraschallbasierten Lokalisationssystem der Prostata (BAT®) bei mit intensitätsmodulierter Radiotherapie behandelten Patienten mit Prostatakarzinom.Patienten und MethodikNach Lagerung entsprechend der externen Hautmarkierung wurden 260/219 ultraschallbasierte Positionierungen vor/nach Bestrahlung bei 32 konsekutiven Patienten durchgeführt. Die Bildqualität wurde als gut, zufriedenstellend oder schlecht bewertet. Patienten- und bildgebungsabhängige Parameter wurden zur Identifikation von Prädiktoren für schlechte Bildqualität analysiert. Verschiebungen im Verhältnis zur Bestrahlungsplanungs-Computertomographie(-CT) wurden in der superior-inferioren (SI), anterior-posterioren (AP) und Rechts-links-(RL-)Achse vor/nach Bestrahlung dokumentiert, um inter-/intrafraktionelle Prostatabewegungen zu bestimmen.ErgebnisseSowohl die Dicke des Gewebes ventral der Blase und das Blasenvolumen während der Ultraschalllokalisation als auch eine inferiore Prostatalage relativ zur Symphyse (bestimmt im Bestrahlungsplanungs-CT) fanden sich als unabhängige Prädiktoren einer schlechten Bildqualität. Interfraktionelle Verschiebungen (Mittelwert ± Standardabweichung: −0,2 ± 4,8 [SI], 2,4 ± 6,6 [AP] und 1,9 ± 4,6 [RL]) variierten viel stärker als intrafraktionelle Verschiebungen (0,0 ± 2,0 [SI], 0,6 ± 2,2 [AP] und 0,2 ± 1,9 [RL]). Ein stärkerer Druck auf die Ultraschallsonde (als eine größere Reduktion des Abstandes Bauchhaut zu Prostata zwischen dem Planungs-CT und dem Ultraschall bestimmt) wurde vor allem bei schlechter Bildqualität ausgeübt, verbunden mit größeren systematischen dorsalen Prostataverschiebungen.SchlussfolgerungIntrafraktionelle Prostataverschiebungen sind deutlich geringer als interfraktionelle Verschiebungen. Blasenfüllung und ein geringer Druck auf die Ultraschallsonde sind zum Erzielen einer adäquaten Bildqualität ohne systematische Prostataverschiebungen entscheidend.

Impact of age and comorbidities on health-related quality of life for patients with prostate cancer: evaluation before a curative treatment

BackgroundInterpretation of comparative health-related quality of life (HRQOL) studies following different prostate cancer treatments is often difficult due to differing patient ages. Furthermore, age-related changes can hardly be discriminated from therapy-related changes. The evaluation of age-and comorbidity-related changes was in focus of this study.MethodsHRQOL of 528 prostate cancer patients was analysed using a validated questionnaire (Expanded Prostate Cancer Index Composite) before a curative treatment. Patients were divided into age groups ≤65, 66-70, 71-75 and >75 years. The impact of specific comorbidities and the Charlson Comorbidity Index (CCI) were evaluated. The questionnaire comprises 50 items concerning the urinary, bowel, sexual and hormonal domains for function and bother. For assessment of sexual and hormonal domains, only patients without prior hormonal treatment were included (n = 336).ResultsUrinary incontinence was observed increasingly with higher age (mean function scores of 92/88/85/87 for patients ≤65, 66-70, 71-75 and >75 years) - complete urinary control in 78%/72%/64%/58% (p < 0.01). Sexual function scores decreased particularly (48/43/35/30), with erections sufficient for intercourse in 68%/50%/36%/32% (p < 0.01) - a decrease of more than a third comparing patients ≤65 vs. 66-70 (36%) and 66-70 vs. 71-75 years (39%). The percentage of patients with comorbidities was lowest in the youngest group (48% vs. 66%/68%/63% for ages 66-70/71-75/>75 years; p < 0.05). A multivariate analysis revealed an independent influence of both age and comorbidities on urinary incontinence, specifically diabetes on urinary bother, and both age and diabetes on sexual function/bother. Rectal domain scores were not significantly influenced by age or comorbidities. A CCI>5 particularly predisposed for lower urinary and sexual HRQOL scores.ConclusionUrinary continence and sexual function are the crucial HRQOL domains with age-related and independently comorbidity-related decreasing scores. The results need to be considered for the interpretation of comparative studies or longitudinal changes after a curative treatment.

Quality of Life After Whole Pelvic Versus Prostate-Only External Beam Radiotherapy for Prostate Cancer: A Matched-Pair Comparison

PURPOSE Comparison of health-related quality of life after whole pelvic (WPRT) and prostate-only (PORT) external beam radiotherapy for prostate cancer. METHODS AND MATERIALS A group of 120 patients (60 in each group) was surveyed prospectively before radiation therapy (RT) (time A), at the last day of RT (time B), at a median time of 2 months (time C) and >1 year after RT (time D) using a validated questionnaire (Expanded Prostate Cancer Index Composite). All patients were treated with 1.8- to 2.0-Gy fractions up to 70.2 to 72.0 Gy with or without WPRT up to 45 to 46 Gy. Pairs were matched according to the following criteria: age±5 years, planning target volume±10 cc (considering planning target volume without pelvic nodes for WPRT patients), urinary/bowel/sexual function score before RT±10, and use of antiandrogens. RESULTS With the exception of prognostic risk factors, both groups were well balanced with respect to baseline characteristics. No significant differences were found with regard to urinary and sexual score changes. Mean bladder function scores reached baseline levels in both patient subgroups after RT. However, bowel function scores decreased significantly more for patients after WPRT than in those receiving PORT at all times (p<0.01, respectively). Significant differences were found for most items in the bowel domain in the acute phase. At time D, patients after WPRT reported rectal urgency (>once a day in 15% vs. 3%; p=0.03), bloody stools (≥half the time in 7% vs. 0%; p=0.04) and frequent bowel movements (>two on a typical day in 32% vs. 7%; p<0.01) more often than did patients after PORT. CONCLUSION In comparison to PORT, WPRT (larger bladder and rectum volumes in medium dose levels, but similar volumes in high dose levels) was associated with decreased bowel quality of life in the acute and chronic phases after treatment but remained without adverse long-term urinary effects.