Hypofractionated Radiation Shortens Prostate Cancer Treatment with Little Quality of Life Impact

Hypofractionated Radiation Shortens Prostate Cancer Treatment with Little Quality of Life Impact

Treating early stage prostate cancer with hypofractionated radiation therapy (HRT) results in fairly similar health-related quality of life outcomes as conventional radiation therapy (CRT), but reduces treatment time by up to one-third, according to a study by Deborah Watkins Bruner, PhD, and colleagues at the Winship Cancer Institute of Emory University.

The study, “NRG Oncology/RTOG 0415, Phase 3 Noninferiority Study Comparing 2 Fractionation Schedules in Patients With Low-Risk Prostate Cancer: Prostate-Specific Quality of Life Results,” was presented at the 58th Annual Meeting of the American Society for Radiation Oncology (ASTRO), September 25-28, in Boston.

“Studies have suggested that higher amounts of radiation over shorter periods of time might be more effective in destroying cancer cells, but the concern has been that stronger doses might also cause quality of life issues such as more diarrhea or decrease in sexual function,” Bruner said in a news release.

To address the concern, the researchers looked at the NRG Oncology/RTOG 0415 randomized Phase 3 trial (NCT00331773) that evaluated the effectiveness of hypofractionated RT versus conventional RT. In the study, patients with stage 2 prostate cancer, median age 67 years, were randomized to receive either CRT (73.8 Gy in 41 daily treatments delivered over 8.2 weeks) or HRT (70 Gy in 28 daily treatments delivered over 5.6 weeks).

Although the study’s efficacy results had already been reported, nothing was known regarding the study patients’ quality of life.

For the current study, data was gathered using a questionnaire specifically designed to evaluate side effects after prostate cancer treatment – the Expanded Prostate Index Composite (EPIC). It evaluates four domains: bowel, urinary, sexual, and hormonal. The higher the score, the better the biological function of each parameter. Among 962 patients from the first study who agreed to participate in the quality of life followup, 478 men had received CRT and 448 men had received HRT. The questionnaires were completed at baseline, six months, and one year after the treatment.

Compared to men without prostate cancer, most patients had poor EPIC sexual domain scores before receiving any of the treatments (median 44.2 and 47.5 for the CRT group and HRT group, respectively) and only slightly lower than average bowel and urinary scores.

Six months after treatment, no significant difference in quality of life were reported by patients of either therapy group. One year after the treatment, patients who had received HRT reported a larger decline in the bowel quality of life compared to those who received CRT, but researchers did not consider this change clinically significant.

“This research shows that hypofractionated radiation therapy offers patients value-based care for their disease,” Bruner said. “If patients with low-risk prostate cancer choose radiation therapy, they can live equally long and have the same quality of life outcomes with 28 daily treatments, compared to what has been the standard care of 41 daily treatments.”