- 作者：Harvey Quon ; M.D.&lowast ; ; &dagger ; ; Patrick C.F. Cheung ; M.D.&lowast ; ; &dagger ; ; patrick.cheung@sunnybrook.ca ; D. Andrew Loblaw ; M.D. ; M.Sc.&lowast ; ; &dagger ; ; Gerard Morton ; M.B.&lowast ; ; &dagger ; ; Geordi Pang ; Ph.D.&lowast ; ; &dagger ; ; Ewa Szumacher ; M.D.&lowast ; ; &dagger ; ; Cyril Danjoux ; M.D.&lowast ; ; &dagger ; ; Richard Choo ; M.D.&Dagger ; ; Alex Kiss ; Ph.D.&lowast ; ; Alexandre Mamedov ; B.Sc.&lowast ; ; Andrea Deabreu ; C.C.R.P.&lowast ;
- 关键词：Prostatic neoplasms ; Radiotherapy ; Intensity-modulated radiotherapy ; Hypofractionation ; Quality of life
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 期刊代码：136_03603016
- 类别：med
- 出版时间：1 June, 2012
- 卷：83
- 期：2
- 页码：617-623
- 文件大小：549 K
Purpose
To evaluate the change in health-related quality of life (QOL) of patients with high-risk prostate cancer treated using hypofractionated radiotherapy combined with long-term androgen deprivation therapy.Methods and Materials
A prospective Phase I-II study enrolled patients with any of the following: clinical Stage T3 disease, prostate-specific antigen level 鈮?0 ng/mL, or Gleason score 8-10. Radiotherapy consisted of 45 Gy (1.8 Gy per fraction) to the pelvic lymph nodes with a concomitant 22.5 Gy intensity-modulated radiotherapy boost to the prostate, for a total of 67.5 Gy (2.7 Gy per fraction) in 25 fractions over 5 weeks. Daily image guidance was performed using three gold seed fiducials. Quality of life was measured using the Expanded Prostate Cancer Index Composite (EPIC), a validated tool that assesses four primary domains (urinary, bowel, sexual, and hormonal).
Results
From 2004 to 2007, 97 patients were treated. Median follow-up was 39 months. Compared with baseline, at 24 months there was no statistically significant change in the mean urinary domain score (p = 0.99), whereas there were decreases in the bowel (p < 0.01), sexual (p < 0.01), and hormonal (p < 0.01) domains. The proportion of patients reporting a clinically significant difference in EPIC urinary, bowel, sexual, and hormonal scores at 24 months was 27%, 31%, 55%, and 60%, respectively. However, moderate and severe distress related to these symptoms was minimal, with increases of only 3%and 5%in the urinary and bowel domains, respectively.
Conclusions
Hypofractionated radiotherapy combined with long-term androgen deprivation therapy was well tolerated. Although there were modest rates of clinically significant patient-reported urinary and bowel toxicity, most of this caused only mild distress, and moderate and severe effects on QOL were limited. Additional follow-up is ongoing to characterize long-term QOL.