Reduction in Patient-reported Acute Morbidity in Prostate Cancer Patients Treated With 81-Gy Intensity-modulated Radiotherapy Using Reduced Planning Target Volume Margins and Electromagnetic Tracking: Assessing the Impact of Margin Reduction Study

Sandler, Howard M.; Liu, Ping-Yu; Dunn, Rodney L.; Khan, David C.; Tropper, Scott E.; Sanda, Martin G.; Mantz, Constantine A.

doi:10.1016/j.urology.2009.10.072

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Volume 75, Issue 5 , Pages 1004-1008, May 2010

Reduction in Patient-reported Acute Morbidity in Prostate Cancer Patients Treated With 81-Gy Intensity-modulated Radiotherapy Using Reduced Planning Target Volume Margins and Electromagnetic Tracking: Assessing the Impact of Margin Reduction Study

Presented at the 51st annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO), November 1-4, 2009.

Howard M. Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
- Reprint requests: Howard M. Sandler, M.D., M.S., Department of Radiation Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048
Ping-Yu Liu
- Fred Hutchinson Cancer Research Center, Seattle, Washington
Rodney L. Dunn
- Department of Urology, University of Michigan, Ann Arbor, Michigan
David C. Khan
- 21st Century Oncology, Santa Monica, California
Scott E. Tropper
- 21st Century Oncology, Scottsdale, Arizona
Martin G. Sanda
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
Constantine A. Mantz
- 21st Century Oncology, Cape Coral, Florida

Received 24 September 2009; accepted 25 October 2009. published online 15 February 2010.

Objective

To investigate whether patient-reported quality of life after high-dose external beam intensity-modulated radiotherapy for prostate cancer can be improved by decreasing planning target volume margins while using real-time tumor tracking.

Methods

Study patients underwent radiotherapy with nominal 3-mm margins and electromagnetic real-time tracking. Morbidity was assessed before and at the end of radiotherapy using Expanded Prostate Cancer Index Composite (EPIC) questionnaires. Changes in scores were compared between the Assessing Impact of Margin Reduction (AIM) study cohort and the comparator Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROST-QA) cohort, treated with conventional margins.

Results

The 64 patients in the prospective AIM study had generally less favorable clinical characteristics than the 153 comparator patients. Study patients had similar or slightly poorer pretreatment EPIC scores than comparator patients in bowel, urinary, and sexual domains. AIM patients receiving radiotherapy had less bowel morbidity than the comparator group as measured by changes in mean bowel and/or rectal domain EPIC scores from pretreatment to 2 months after start of treatment (−1.5 vs −16.0, P = .001). Using a change in EPIC score >0.5 baseline standard deviation as the measure of clinical relevance, AIM study patients experienced meaningful decline in only 1 health-related quality of life domain (urinary) whereas decline in 3 health-related quality of life domains (urinary, sexual, and bowel/rectal) was observed in the PROST-QA comparator cohort.

Conclusions

Prostate cancer patients treated with reduced margins and tumor tracking had less radiotherapy-related morbidity than their counterparts treated with conventional margins. Highly contoured intensity-modulated radiotherapy shows promise as a successful strategy for reducing morbidity in prostate cancer treatment.