TY - JOUR
T1 - Long-Term Quality-of-Life Outcomes After Prostate Radiation Therapy With or Without High-Dose-Rate Brachytherapy Boost
T2 - Post Hoc Analysis of TROG 03.04 RADAR
AU - Ong, Wee Loon
AU - Nikitas, John
AU - Joseph, David
AU - Steigler, Allison
AU - Millar, Jeremy
AU - Valle, Luca
AU - Steinberg, Michael L.
AU - Ma, Ting Martin
AU - Reiter, Robert E.
AU - Rettig, Matthew B.
AU - Nickols, Nicholas G.
AU - Chang, Albert
AU - Zaorsky, Nicholas G.
AU - Spratt, Daniel E.
AU - Romero, Tahmineh
AU - Kishan, Amar U.
N1 - Funding Information:
Disclosures: A.U.K. reports personal fees from ViewRay, Inc, Varian Medical Systems, Inc, and Janssen Pharmaceuticals outside the submitted work, as well as research funding from ViewRay. D.E.S. reports personal fees from Janssen Pharmaceuticals and Blue Earth outside the submitted work. This study was supported by the RANZCR-TROG Research Grant (W.L.O.), grants P50CA09213 (A.U.K.) and P50CA186786 (D.E.S.) from the Prostate Cancer National Institutes of Health Specialized Programs of Research Excellence, grant RSD1836 from the Radiological Society of North America (A.U.K.), the STOP Cancer Organization (A.U.K.), grants PC210066 (A.U.K.) and PC151068 (D.E.S.) from the Department of Defense, the Prostate Cancer Foundation (A.U.K., D.E.S., and N.G.N.), funding from the Jonsson Comprehensive Cancer Center (A.U.K.), and funding from the Chapgier, Bershad, De Silva, and McCarrick Families (A.U.K.). The sources of funding support had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2024/7/1
Y1 - 2024/7/1
N2 - Purpose: Adding high-dose-rate brachytherapy (BT) boost to external beam radiation therapy (EBRT) improves biochemical control but may affect patient-reported quality of life (QOL). We sought to determine long-term QOL outcomes for EBRT+BT versus EBRT alone. Methods and Materials: This was a post hoc analysis of the Trans-Tasman Radiation Oncology Group 03.04 Randomized Androgen Deprivation and Radiotherapy (TROG 03.04 RADAR) trial. Only patients who received 74 Gy conventionally fractionated EBRT (n = 260) or 46 Gy conventionally fractionated EBRT plus 19.5 Gy in 3 fractions high-dose-rate BT boost (n = 237) were included in this analysis. The primary endpoint was patient-reported QOL measured using the European Organisation for Research and Treatment of Cancer QOL (EORTC QLQ-C30) and prostate-specific QOL module (EORTC QLQ-PR25) questionnaires. We evaluated temporal changes in QOL scores, rates of symptom resolution, and the proportion of men who had decrements from baseline of >2 × the threshold for minimal clinically important change (2 × MCIC) for each domain. Results: At 5, 17, and 29 months after radiation therapy, the EBRT+BT group had 2.5 times (95% confidence interval [CI], 1.4-4.2; P < .001), 2.9 times (95% CI, 1.7-4.9; P < .001), and 2.6 times (95% CI, 1.4-4.6; P = .002) greater odds of reporting 2 × MCIC in urinary QOL score compared with EBRT. There were no differences beyond 29 months. EBRT+BT led to a slower rate of urinary QOL symptom score resolution up to 17 months after radiation therapy compared with EBRT (P < .001) but not at later intervals. In contrast, at the end of the radiation therapy period and at 53 months after radiation therapy, the EBRT+BT group had 0.65 times (95% CI, 0.44-0.96; P = .03) and 0.51 times (95% CI, 0.32-0.79; P = .003) the odds of reporting 2 × MCIC in bowel QOL symptom scores compared with EBRT. There were no significant differences in the rate of bowel QOL score resolution. There were no significant differences in global health status or sexual activity scores between the 2 groups. Conclusions: There were no persistent differences in patient-reported QOL measures between EBRT alone and EBRT+BT. BT boost does not appear to negatively affect long-term, patient-reported QOL.
AB - Purpose: Adding high-dose-rate brachytherapy (BT) boost to external beam radiation therapy (EBRT) improves biochemical control but may affect patient-reported quality of life (QOL). We sought to determine long-term QOL outcomes for EBRT+BT versus EBRT alone. Methods and Materials: This was a post hoc analysis of the Trans-Tasman Radiation Oncology Group 03.04 Randomized Androgen Deprivation and Radiotherapy (TROG 03.04 RADAR) trial. Only patients who received 74 Gy conventionally fractionated EBRT (n = 260) or 46 Gy conventionally fractionated EBRT plus 19.5 Gy in 3 fractions high-dose-rate BT boost (n = 237) were included in this analysis. The primary endpoint was patient-reported QOL measured using the European Organisation for Research and Treatment of Cancer QOL (EORTC QLQ-C30) and prostate-specific QOL module (EORTC QLQ-PR25) questionnaires. We evaluated temporal changes in QOL scores, rates of symptom resolution, and the proportion of men who had decrements from baseline of >2 × the threshold for minimal clinically important change (2 × MCIC) for each domain. Results: At 5, 17, and 29 months after radiation therapy, the EBRT+BT group had 2.5 times (95% confidence interval [CI], 1.4-4.2; P < .001), 2.9 times (95% CI, 1.7-4.9; P < .001), and 2.6 times (95% CI, 1.4-4.6; P = .002) greater odds of reporting 2 × MCIC in urinary QOL score compared with EBRT. There were no differences beyond 29 months. EBRT+BT led to a slower rate of urinary QOL symptom score resolution up to 17 months after radiation therapy compared with EBRT (P < .001) but not at later intervals. In contrast, at the end of the radiation therapy period and at 53 months after radiation therapy, the EBRT+BT group had 0.65 times (95% CI, 0.44-0.96; P = .03) and 0.51 times (95% CI, 0.32-0.79; P = .003) the odds of reporting 2 × MCIC in bowel QOL symptom scores compared with EBRT. There were no significant differences in the rate of bowel QOL score resolution. There were no significant differences in global health status or sexual activity scores between the 2 groups. Conclusions: There were no persistent differences in patient-reported QOL measures between EBRT alone and EBRT+BT. BT boost does not appear to negatively affect long-term, patient-reported QOL.
UR - http://www.scopus.com/inward/record.url?scp=85174849234&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2023.09.051
DO - 10.1016/j.ijrobp.2023.09.051
M3 - Article
C2 - 37802226
AN - SCOPUS:85174849234
SN - 0360-3016
VL - 119
SP - 813
EP - 825
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 3
ER -
