PROs Support Hypofractionated Radiotherapy For Localised Prostate Cancer

Author: By Lynda Williams, Senior medwireNews Reporter

medwireNews: The National Prostate Cancer Audit has found no clinically significant differences in the patient-reported outcomes (PROs) of men with nonmetastatic disease who were given hypofractionated radiotherapy (H-RT) or a conventional (C-RT) regimen. 

Acknowledging that hypofractionated treatment offers the benefits of “greater convenience and shorter total duration of treatment” than C-RT, the investigators say that their study “supports recent guidelines that recommend H-RT with a moderately hypofractionated regimen as the standard of care for men with nonmetastatic [prostate cancer].” 

Overall, 17,058 men in England and Wales who were diagnosed with prostate cancer between 2014 and 2016 were asked to complete a postal questionnaire at least 18 months after diagnosis regarding their functional outcomes and health-related quality of life (HRQoL), explain lead investigator Julie Nossiter, from the London School of Hygiene and Tropical Medicine in the UK, and colleagues. 

The 4699 responders who had been treated with H-RT (49–61 Gy delivered in 16–20 fractions) were older than the 8432 men who instead were treated with C-RT (68–80 Gy delivered over 32–40 fractions), with 67.5% versus 60.9% aged at least 70 years. 

Men in the H-RT group were also less likely to have locally advanced prostate cancer (56.5 vs 71.3%) or to have received androgen deprivation therapy (79.5 vs 87.8%) than the C-RT group, but were slightly more likely to have undergone genitourinary procedures before surgery (24.2 vs 21.2%). 

Analysis of responses to the Expanded Prostate Cancer Index Composite short-form 26 survey showed that H-RT was associated with small but significant benefits in the sexual and hormone function scores compared with C-RT, although these “failed to meet established thresholds for a clinically meaningful change”, the researchers observe. 

There were no significant differences detected between the H-RT and C-RT arms with regard to the urinary incontinence, urinary obstruction and bowel function domains in the survey.  

And the EQ-5D-5L assessment failed to show any significant differences between the H-RT and C-RT cohorts with regard to HRQoL associated with mobility, self-care, usual activities, pain or discomfort or anxiety and depression. 

“Our results which demonstrate a lack of clinically relevant differences in PROs and HRQoL add to the growing evidence base for the use of H-RT in men with nonmetastatic [prostate cancer]”, the researchers summarise in the Journal of Clinical Oncology. 

Noting that the majority (90%) of men gave PROs 2 years after beginning radiotherapy, the authors admit that “[i]t is possible that differences in outcomes according to the type of RT become apparent 5 to 10 years after treatment” but emphasize that “results from [randomised controlled trials] comparing C-RT with H-RT do not demonstrate a consistent increase in late toxicity associated with hypofractionation.”

Reference 

Nossiter J, Sjuenthiran A, Cowling TE, et al. Patient-reported functional outcomes after hypofractionated or conventionally fractionated radiation for prostate cancer: a national cohort Study in England. J Clin Oncol; Advance online publication 2 January 2020. DOI: 10.1200/JCO.19.01538