Varying Radiation Regimens by Dose, Time Show Similar Long-Term Quality of Life Outcomes in Prostate Cancer

In patients with prostate cancer, while reported quality of life remained relatively similar after six years regardless of the type or dosage of radiation therapy received, more toxicities were seen by patients who received ultra-hypofractionation (higher dosage) compared to those who received conventional fractionation (regular dosage) therapy, according to data published in Lancet.

“Before ultra-hypofractionation radiotherapy schedules should become standard, it is important to assess patient reported outcomes of long-term quality of life in comparison with conventional fractionation,” the authors noted in their paper.

In this phase 3 study, researchers treated 1,180 patients from Sweden and Denmark with histologically verified intermediate to high-risk prostate cancer. There were 591 patients assigned to receive conventional fractionation (78-0 Gy in 39 fractions, five days per week for eight weeks). The remaining 589 patients received ultra-hypofractionation (42-7 Gy in seven fractions, three days per week for two to five weeks).

To measure quality of life, researchers used the Prostate Cancer Symposium Scale and European Organization for Researcher and Treatment of Cancer Quality of Life Questionnaire. Patients reported at baseline, the end of radiotherapy, at three, six, 12 and 24 months after radiotherapy, then every other year after up to 10 and 15 years. The median follow up was 48 months, and 1,165 patients were included in this quality-of-life analysis. Of the total, 158 received conventional fractionation while 146 received ultra-hypofractionation.

The clinically relevant problems in those treated with ultra-hypofractionation included mostly gastrointestinal problems such as stool frequency, rush to toilet, flatulence, bowel cramp, mucus, blood in stool and limitation in daily activity. These changes were seen after radiotherapy ended and for up to one year after.

After six years, however, there was no difference of incidence of problems between the groups including urinary bother (43 [33%] for conventional fractionation; 33 [28%] for ultra-hypofractionation), overall bowel bother (43 [33%] for conventional fractionation; 34 [28%] for ultra-hypofractionation), overall sexual bother (75 [60%] for conventional fractionation; 59 [50%] ultra-hypofractionation), quality of life (56 [42%] for conventional fractionation; 46 [37%] ultra-hypofractionation).

“These findings are important for the ongoing discussion and development of radiotherapy treatment modalities inducing moderately hypofractionation and ultra-hypofractionation radiotherapy, “authors say. “The increasing number of large, randomized studies reporting toxicity and quality of life outcomes are important in confirming that both moderately hypo fractionated, and ultra-hypo fractionated radiotherapy can be safely delivered.”

The authors noted some limitations of this study, including the exclusion of patients with disease progression from the quality of life analysis, as well as the questionnaire itself, which is not used widely outside of Scandinavia. This could affect the comparison of results to other studies, they explained.

“Longer term reported outcomes will help clarify whether late emergent differences exist between ultra-hypofractionated and conventionally fractionated radiotherapy,” the authors concluded.

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