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.
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