Patient-Reported Functional Outcomes After Hypofractionated or Conventionally Fractionated Radiation for Prostate Cancer

1. In men with prostate cancer, functional outcomes following moderately hypofractionated radiation therapy are clinically equivalent to those following conventionally fractionated radiation therapy.

Evidence Rating Level: 2 (Good)

External-beam radiation therapy (RT) is a primary radical treatment option for men with localized or locally advanced prostate cancer. The conventionally fractionated RT regimen (C-RT) has traditionally been the standard of care, but a moderately hypofractionated regimen (H-RT) may offer a therapeutic and economic advantage by decreasing toxic effects. Several recent studies have demonstrated similar efficacy of C-RT and H-RT, but few have studied patient-reported outcomes, which may more reliably detect adverse treatment effects that are relevant to patients. In this retrospective cohort study, 17,058 men with prostate cancer underdoing either C-RT or H-RT were studied to compare patient-reported functional outcomes. Of the study cohort, 77% of participants responded, and 64.2% of those received C-RT. Men in the H-RT group were more likely to be older and have had pretreatment genitourinary procedures, and were less likely to have locally advanced disease and to have received androgen-deprivation therapy. Researchers found that H-RT was associated with statistically significantly higher Expanded Prostate Cancer Index Composite short-form 26 sexual scores (adjusted mean difference 3.3 points, 95% CI 2.1 to 4.5, p<0.001) and hormonal function scores (adjusted mean difference 3.2 points, 95% CI 1.8 to 4.6, p<0.001) than C-RT. However, these differences did not meet established thresholds for a clinically meaningful change. This study was limited by the lack of patient-reported outcomes immediately before treatment. Overall, the findings support recent guidelines that recommend H-RT as the standard of care for men with nonmetastatic prostate cancer.

Click to read the study in JCO

Image: PD

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