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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Comparison of conventional-dose vs. high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate.JAMA. 2005; 294: 1233-1239
- Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer.Int J Radiat Oncol Biol Phys. 2008; 70: 67-74
- Dose–response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy.J Clin Oncol. 2006; 24: 1990-1996
- Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomized controlled trial.Lancet Oncol. 2007; 8: 475-487
- Dosimetric impact and theoretical clinical benefits of fiducial markers for dose escalated prostate cancer radiation treatment.Int J Radiat Oncol Biol Phys. 2009; 74: 1128-1133
- The effect of changing technique, dose, and PTV margin on therapeutic ratio during prostate radiotherapy.Int J Radiat Oncol Biol Phys. 2008; 71: 1057-1064
- Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer.Urology. 2000; 56: 899-905
- Multi-institutional clinical experience with the Calypso system in localization and continuous, real-time monitoring of the prostate gland during external radiotherapy.Int J Radiat Oncol Biol Phys. 2007; 67: 1088-1098
- Quality of life and satisfaction with outcome among prostate-cancer survivors.N Engl J Med. 2008; 358: 1250-1261
- (Accessed August 12, 2009)
- Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation.Med Care. 2003; 41: 582-592
- Influence of intrafraction motion on margins for prostate radiotherapy.Int J Radiat Oncol Biol Phys. 2006; 65: 548-553
- Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial.Lancet. 1999; 353: 267-272
- Acute and late gastrointestinal toxicity after radiotherapy in prostate cancer patients: consequential late damage.Int J Radiat Oncol Biol Phys. 2006; 66: 3-10
- Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer.Int J Radiat Oncol Biol Phys. 2008; 70: 1124-1129
Article info
Publication history
Published online: February 15, 2010
Accepted:
October 25,
2009
Received:
September 24,
2009
Footnotes
Supported by Calypso Medical Technologies, Inc. and NIHR01CA 95662.
P-Y Liu, and R.L. Dunn, are paid statistical consultants for Calypso Medical Technologies, Inc.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
