Quality of life after three different first-line radiation therapies for localized disease: Part 2


This is the second of three reports discussing a recent, detailed paper by Evans et al. The first (Part 1) was published yesterday, on Tuesday, August 25, and Part 3 will be published tomorrow (Thursday, August 27).

PART 2. DETAILED FINDINGS

In this part we’ll look at the results of the authors’ analysis. They did a great job of compiling a vast amount of information. Even so, in some cases, I wish more of the information had been presented. (I was able to see the full text of the paper.) Perhaps they will reveal more of the details in future analyses of this rich database.

Change from baseline

The table immediately below shows the EPIC score change from baseline after 2 years among patients having each kind of therapy. The last column shows, for reference, the minimum amount of change that has been found to be clinically important for that set of symptoms.

Edel

Sexual status was the domain that was most affected by all the treatments. For LDRBT, it had the greatest deterioration. Deterioration in urinary and bowel scores were statistically significant and clinically meaningful in patients who had LDRBT. IMRT also had its greatest impact on sexual status, and not much different from LDRBT. Other than sexual status, only IMRT bowel scores deteriorated meaningfully; urinary status returned to near baseline. SBRT had the smallest change in sexual status, albeit large enough to be meaningful. Bowel and urinary status returned to baseline.

Minimal clinically detectable change

The authors also looked at what percent of patients suffered a minimal clinically detectable (MCD) change in each of those components of their quality of life over time. The typical pattern was a sharp increase at 1 or 2 months (acute effects). In all but sexual scores, that was followed by improvement. Predictably, urinary irritation/obstructive were most impacted, reaching about 90 percent at 2 months for LDRBT, and significantly better at all time points for IMRT and SBRT. The proportion who had MCD bowel symptoms and sexual symptoms was consistently more favorable for SBRT than for LDRBT or IMRT.

As a measure of the severity of symptoms, the authors looked at the percentage of patients who suffered an MCD increase of twofold or more over baseline after 2 years:

Edel2

In general, large clinical deteriorations in QOL were about twice as frequent for LDRBT compared to SBRT, with IMRT falling in the middle.

Symptom severity over time

As another measure of symptom severity, the next table shows the percent change versus baseline in the proportion who rated their symptoms as moderate to severe, at 1-2 months and at 2 years:

Edel3

Moderate to severe acute urinary and rectal side effects increased markedly for LDRBT and IMRT. For SBRT, they increased much less and returned to slightly better than baseline levels.

Keeping in mind that LDRBT patients were a median of 5 years younger than the other two groups, the increase in erectile dysfunction among LDRBT patients is troubling. As we saw in a recent study, the deterioration occurs earlier than was previously thought. For SBRT, in contrast, there was only a +5 percent increase in erectile dysfunction severity at 2 months after treatment, but that increased to +11 percent by 2 years. Nevertheless, that was still lower than the other two therapies.

Editorial note: This commentary was written for The “New” Prostate Cancer InfoLink by Allen Edel, who was treated with SBRT in 2010. Part 3 of this report will be made available tomorrow (Thursday, August 27).

One Response

  1. Super-important because most people try to convince patients that brachytherapy has minimal effects on ED. Not true. If one asks as a patient, the radiation oncologist will just dismiss you and say, “Well at your age, everyone has a chance of ED.” (I was 56 when treated and ED began at 57.)

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