PMID- 31113644
OWN - NLM
STAT- MEDLINE
DCOM- 20201030
LR  - 20201030
IS  - 1873-7560 (Electronic)
IS  - 0302-2838 (Linking)
VI  - 76
IP  - 5
DP  - 2019 Nov
TI  - Patient-reported Outcomes and Late Toxicity After Postprostatectomy 
      Intensity-modulated Radiation Therapy.
PG  - 686-692
LID - S0302-2838(19)30415-4 [pii]
LID - 10.1016/j.eururo.2019.05.011 [doi]
AB  - BACKGROUND: Limited long-term data characterize patient-reported quality of life 
      (QOL) following postprostatectomy intensity-modulated radiation therapy (PPRT), 
      and predictors of decline are poorly defined. OBJECTIVE: To identify modifiable 
      dosimetric and clinical risk factors impacting QOL and late toxicity following 
      PPRT. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study of 
      consecutive men with prostate cancer who received PPRT between 2007 and 2015 at a 
      single academic institution. INTERVENTION: Patients were prospectively evaluated 
      using the Expanded Prostate Cancer Index Composite (EPIC-26) QOL instrument. 
      Radiation Therapy Oncology Group/Common Toxicity Criteria for Adverse Events 
      toxicity grades were assigned at every follow-up visit. Treatment was delivered 
      to the prostate bed (median 68Gy)+/-pelvic lymphatics (65%, median 50.4Gy) with 
      daily image guidance. Androgen deprivation therapy was concomitantly administered 
      to 132 (66%) men for a median of 4mo. OUTCOME MEASUREMENTS AND STATISTICAL 
      ANALYSIS: Changes were deemed relevant if they exceeded the minimally clinically 
      important difference (MCID), as calculated by a distribution-based method. 
      Generalized estimating equation models and Cox regression were used for QOL and 
      late toxicity univariate and multivariable analysis. RESULTS AND LIMITATIONS: 
      Overall, 199 men were identified with a median follow-up of 33mo. Overall urinary 
      function (UF), bowel function (BF), sexual function (SF), and urinary 
      irritation/obstruction (UI/UO) scores were never lower than the MCID. Between 8% 
      and 18% of men experienced a small multidomain (1x MCID) decline, and 0-8% 
      experienced a moderate multidomain decline (2x MCID) at a given time point up to 
      84mo after PPRT. The rates of freedom from grade 2 or higher (Gr2+) genitourinary 
      (GU) and gastrointestinal (GI) toxicity were 94% and 95%, respectively, at 4yr. 
      Factors associated with worse QOL or toxicity included longer time to PPRT (UC 
      and UF), higher BMI (UF, BF, and late GI toxicity), older age (BF, SF, and late 
      GU toxicity); hormone therapy (SF), total dose (late GI toxicity), tobacco 
      history (BF), and higher bladder V70Gy (UC, UF, and late GU toxicity). 
      CONCLUSIONS: Long-term QOL and late toxicity are favorable following 
      postprostatectomy radiation therapy. Identifiable clinical and dosimetric risk 
      factors may guide decision making to optimize urinary, sexual, and bowel 
      function. PATIENT SUMMARY: The following study provides a detailed report of 
      favorable patient-reported quality of life and late side-effect profiles of 
      radiation therapy following surgery for localized prostate cancer. Our findings 
      provide patients guidance on what symptoms to expect if they are planning to 
      undergo radiation therapy in this setting. It also allows physicians to counsel 
      patients appropriately, and modify certain clinical and radiation-related risk 
      factors to optimize quality of life.
CI  - Copyright (c) 2019 European Association of Urology. Published by Elsevier B.V. All 
      rights reserved.
FAU - Akthar, Adil S
AU  - Akthar AS
AD  - Department of Radiation and Cellular Oncology, University of Chicago, Chicago, 
      IL, USA.
FAU - Liao, Chuanhong
AU  - Liao C
AD  - Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
FAU - Eggener, Scott E
AU  - Eggener SE
AD  - Section of Urology, University of Chicago, Chicago, IL, USA.
FAU - Liauw, Stanley L
AU  - Liauw SL
AD  - Department of Radiation and Cellular Oncology, University of Chicago, Chicago, 
      IL, USA. Electronic address: sliauw@radonc.uchicago.edu.
LA  - eng
PT  - Journal Article
DEP - 20190519
PL  - Switzerland
TA  - Eur Urol
JT  - European urology
JID - 7512719
SB  - IM
CIN - Transl Androl Urol. 2019 Dec;8(6):770-771. PMID: 32038976
MH  - Aged
MH  - Humans
MH  - *Long Term Adverse Effects/etiology/physiopathology/prevention & 
      control/psychology
MH  - Male
MH  - Middle Aged
MH  - Outcome and Process Assessment, Health Care
MH  - Patient Reported Outcome Measures
MH  - Prostatectomy/*methods
MH  - *Prostatic Neoplasms/pathology/psychology/radiotherapy/surgery
MH  - Quality Improvement
MH  - *Quality of Life
MH  - *Radiation Injuries/diagnosis/physiopathology/prevention & control/psychology
MH  - Radiologic Health/standards
MH  - *Radiotherapy, Intensity-Modulated/adverse effects/methods
MH  - Risk Assessment
MH  - Risk Factors
OTO - NOTNLM
OT  - Adjuvant or salvage
OT  - Intensity-modulated radiation therapy
OT  - Late toxicity
OT  - Long term
OT  - Patient-reported outcomes
OT  - Postoperative
OT  - Postprostatectomy
OT  - Prostate cancer
OT  - Quality of life
OT  - Radiation therapy
EDAT- 2019/05/23 06:00
MHDA- 2020/10/31 06:00
CRDT- 2019/05/23 06:00
PHST- 2018/12/08 00:00 [received]
PHST- 2019/05/07 00:00 [accepted]
PHST- 2019/05/23 06:00 [pubmed]
PHST- 2020/10/31 06:00 [medline]
PHST- 2019/05/23 06:00 [entrez]
AID - S0302-2838(19)30415-4 [pii]
AID - 10.1016/j.eururo.2019.05.011 [doi]
PST - ppublish
SO  - Eur Urol. 2019 Nov;76(5):686-692. doi: 10.1016/j.eururo.2019.05.011. Epub 2019 
      May 19.