To analyze long-term quality of life (QoL) changes related to postoperative radiotherapy (RT) after radical prostatectomy.
Patients following postoperative 3D conformal RT in the years 2003-2008 with 1. 8-2.0Gy fractions up to 66.0-66.6Gy (n=181) were surveyed using the EPIC (Expanded Prostate Cancer Index Composite) questionnaire before the beginning of RT (A), at the last day (B), two months (C), 1-3 years (D), 6-9 years (E) and 10-13 years (F) after RT.
Mean urinary bother/urinary incontinence bother/bowel bother score changes (in relation to baseline at time A) of 13/14/7 and 14/15/7 resulted at times E and F, respectively (p<0.01 for all comparisons). Sexual function scores decreased 6 and 8 points on average (p<0.01). Patient age at the time of RT had a considerable impact on urinary bother and urinary incontinence bother, with increasing differences over time comparing patients <68 vs. >68 years: 0 vs. 7 and 0 vs. 7 points at time D; 8 vs. 23 and 6 vs. 35 points at time F, respectively. Patients who did not respond to RT with a decreasing PSA had larger urinary/urinary incontinence bother and bowel bother score changes >10 years after treatment (25 vs. 12; p=0.04 / 36 vs. 10; p=0.03 and 20 vs. 5; p=0.07, respectively). A larger rectal dose was associated with larger acute and long-term bowel bother score decrease. No correlation was found between the dose to the bladder and QoL changes.
In contrast to early evaluations in the first years, significantly decreasing QoL in the urinary, bowel and sexual domains was found >5 years following RT. Aging is likely to be a major factor. Younger patients who responded to the treatment had the most favorable long-term QoL results. As 3D conformal RT was used in this study, intensity-modulated concepts could result in improved outcomes.
International journal of radiation oncology, biology, physics. 2019 Jun 12 [Epub ahead of print]
Friederike Leufgens, Vanessa Berneking, Thomas-Alexander Vögeli, Ruth Kirschner-Hermanns, Michael J Eble, Michael Pinkawa
Department of Radiation Oncology, RWTH Aachen University, Pauwelsstrasse 30, 52072 Aachen, Germany., Department of Radiation Oncology, RWTH Aachen University, Pauwelsstrasse 30, 52072 Aachen, Germany; Department of Radiation Oncology, MediClin Robert Janker Klinik, Villenstrasse 8, 53129 Bonn, Germany., Department of Urology, RWTH Aachen University, Pauwelsstrasse 30, 52072 Aachen, Germany., Department of Urology/Neuro-Urology, Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany., Department of Radiation Oncology, RWTH Aachen University, Pauwelsstrasse 30, 52072 Aachen, Germany; Department of Radiation Oncology, MediClin Robert Janker Klinik, Villenstrasse 8, 53129 Bonn, Germany. Electronic address: .