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Session Item

Physics track: Radiobiological and predictive modelling, and radiomics
9323
Poster
Physics
10:50 - 11:00
Quality of life after EBRT with or without focal boost for prostate cancer in the FLAME trial
OC-0315

Abstract

Quality of life after EBRT with or without focal boost for prostate cancer in the FLAME trial
Authors: GROEN|, Veerle(1)*[v.h.groen@umcutrecht.nl];Monninkhof|, Evelyn(2);Verkooijen|, Helena M.(2);Kunze-Busch|, Martina(3);de Boer|, Hans(1);van der Voort van Zijp|, Jochem(1);Pos|, Floris(4);Smeenk|, Robert Jan(3);Haustermans|, Karin(5);Isebaert|, Sofie(5);Depuydt|, Tom(5);van der Heide|, Uulke A.(4);Kerkmeijer|, Linda(1);
(1)UMC Utrecht, Radiation Oncology, Utrecht, The Netherlands;(2)UMC Utrecht, Epidemiology, Utrecht, The Netherlands;(3)Radboud University Nijmegen Medical Center, Radiation Oncology, Nijmegen, The Netherlands;(4)The Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands;(5)University Hospitals, Radiation Oncology, Leuven, Belgium;
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Purpose or Objective

Survival rates of prostate cancer are improving with advanced treatment options. Therefore, quality of life (QoL) is becoming increasingly important. In the present study, the aim was to compare patient reported health-related Quality of Life (HRQoL) between patients treated with 77Gy external beam radiotherapy in 35 fractions versus those treated with an additional focal boost to the macroscopic tumor nodule(s) up to 95Gy.

Material and Methods

For the present study, we included 571 patients with intermediate and high risk prostate cancer of the multicenter randomized controlled phase III FLAME trial (NCT01168479). In the FLAME trial, patients are asked to fill out the EORTC  QLQ-PR25 (prostate specific) questionnaire at baseline and 1, 6, 12, 24 and 60 months after treatment. A linear mixed model for repeated measurements was used to assess the impact of the focal boost in comparison to standard treatment on HRQoL until 24 months after treatment. Covariates that are corrected for are age, baseline health related QoL and hormonal treatment. Analyses were performed for the separate domains of the prostate specific questionnaire, i.e. urinary symptoms, bowel symptoms, sexual activity and sexual functioning. The sexual activity and sexual functioning domains were analyzed exclusively for patients who did not receive hormonal therapy, resulting in a lower number at risk per follow-up moment.

Results

Of the 571 patients, 13 patients were excluded from further analysis because no HRQoL data was available. Of the 558 remaining patients, 184 patients (33%) did not receive hormonal therapy. There were no significant differences in QoL domains observed between both study arms. Figure 1 shows the observed median (interquartile range (IQR)) QoL per domain per time point. Urinary QoL decreased immediately after treatment and recovered within one year in both treatment arms. Median bowel-related QoL deteriorated little from baseline in the standard treatment arm and did not deteriorate from baseline in the FLAME treatment arm. Sexual activity did not change after radiotherapy. Sexual functioning was affected in both study arms and remained deteriorated over time in the standard treatment arm. In the FLAME treatment arm, sexual functioning recovered again between 12 and 24 months.

Figure 1. Quality of life changes over time for different subdomains of the EORTC  QLQ-PR25, stratified by FLAME treatment arm


*   Higher score represents more symptoms or problems
** Lower score represents more problems

Conclusion

Focal boosting of the tumor up to 95Gy in patients with intermediate and high risk prostate cancer does not deteriorate patient reported QoL compared to standard treatment, provided the same dose constraints to organs at risk are maintained. This is in line with previously published (physician reported) toxicity outcomes in the FLAME trial at two year follow-up.