Abstracts Archive

UK & Ireland Prostate Brachytherapy Conference 2012

Abstract number 4

Impact and recovery of health related quality of life after single fraction HDR brachytherapy and EBRT for prostate cancer. 

J Malik, Clinical Research Fellow Uro-Oncology, C Arthur, Specialist Registrar Clinical Oncology, R Swindell, Department of Medical Statistics, P Mandall, Brachytherapy Data Manager, J Logue, Consultant Clinical Oncology, J Wylie, Consultant Clinical Oncology.
Christie Hospital NHS Foundation Trust, Manchester, UK

Introduction: To investigate the changes in health related quality of life (HRQoL) after single fraction HDR brachytherapy and EBRT for prostate cancer.

Material and Methods: A prospective database collected HRQoL data on all patients treated with HDR and EBRT between July 2008 and February 2011, using Expanded Prostate Cancer Index Composite (EPIC) questionnaire, completed at baseline, 6 weeks, 6 months, 12months, 18 months and 24months.

Median EPIC scores, Interquartile range (IQ) range were calculated and two sided p value of <0.01 was regarded as significant after applying Bonferroni correction for multiple comparisons.

Results: N=177 patients.
T2/T3=154 cases (87%).
Median age 67 years (57-77), PSA 16.0 ng/ml (0.29-102), Gleason score 7(6-10),IPSS 8 (0-27) and duration of hormone therapy 6months (3-28).
HDR dose 12.5Gy till March 2010 and then 15Gy.
EBRT 37.5Gy/15 fractions over 3 weeks, started 3 weeks after HDR.

N=151(85%) completed questionnaire at baseline.

Median baseline EPIC urinary function (UFn) score 100(IQ range 88.0-100) and urinary bother (UBo) score 85.7 (IQ range 75.0-96.6).Urinary scores changed significantly at 6 weeks, median UFn 93.4((85.0-100)(P=0.002) and UBo 78.6 ((64.3-89.3)(p<0.0001)) but returned close to baseline at 6 months. At 6 months only 16.2 % (17/105) patients had ≥10% drop in EPIC total urinary score compared to baseline.

Median baseline EPIC bowel function (BFn) score 96.4 (92.9-100) and bowel bother (BBo) score 100 (92.9-100) and dropped significantly at 6 weeks with BFn 89.3 ((78.6-96.5) (p<0.0001)) and BBo 89.3((78.6-100)(p<0.0001)) but returned to baseline at 24 months. At 24 months only 18% (6/33) had total bowel score ≥10% lower from baseline.

Conclusion: Median EPIC urinary scores recovered by 6 months, and median bowel scores after 18months. A single fraction HDR boost in combination with hypofractionated EBRT provides a convenient method of dose escalation with acceptable medium term impact on urinary and bowel QoL.