- Email: [email protected]
Does Hormone Therapy Exacerbate the Adverse Effects of Radiotherapy in the Treatment of Men with Prostate Cancer? A Quality of Life Study
I. J. Radiation Oncology d Biology d Physics
S598
Volume 78, Number 3, Supplement, 2010
dysfunction (ED) was measured using the Sexual Health Inventory for Men (SHIM) questionnaire (22-25 = no ED, 17-21 = mild ED, 12-16 = mild to moderate ED, 8-11 = moderate ED, and 1-7 = severe); ED was also graded by the physician-assessed Mount Sinai Erectile Function (MSEF) score (0 = no erectile function, 1 = erections insufficient for intercourse, 2 = erections sufficient for intercourse but suboptimal, and 3 = optimal erections). Multivariate analysis was also performed to take into account HR and total dose delivered (measured in BED). Results: Mean IPSS scores for group 1 at 1 yr, 2 yr, 5 yr, and 7 yr follow-up, were 10.2, 9.4, 7.4, and 7.5, respectively. In comparison, mean IPSS scores for group 2 at 1 yr, 2 yr, 5 yr, and 7 yr follow-up, were 10.2, 9.6, 8.5, and 8.3, respectively. For groups 1 and 2, average changes in SHIM scores were, respectively, -4.0 and -6.6 at 1yr (p = 2, post-treatment scores = \1 were noted, respectively, in 26% and 56% of patients at 1yr; 27% and 47% at 2yr; 35% and 60% at 5yr; and 42% and 64% at 7yr (p \ .001 for all years). Of note, more patients received HR in group 2 than in group 1 (87% vs. 38%, respectively); the median duration of HR was longer for group 2 than group 1 (9 mo vs. 6 mo, respectively). Multivariable analyses identified both treatment group and HR as significant causes of decreases in MSEF at year 1 (p \ 0.001 and p = .001, respectively), but at year 2, only the treatment group was significant and HR was not (p = .005 and p = .191, respectively); at year 5, treatment group remained significant and HR was not (p = .016 and p = .507, respectively). Total dose delivered did not independently predict a decrease in MSEF. Conclusions: Patients receiving BR + EBRT are more likely to experience erectile dysfunction than patients receiving BR alone; HR was also noted to independently predict decreases in ED in the first year after treatment, but was no longer significant after 2 yr follow-up. No differences in urinary symptoms were observed. Author Disclosure: I.E. Friedman, None; K. Forsythe, None; N.N. Stone, Prologics, LLC, E. Ownership Interest; Nihon MediPhysics, F. Consultant/Advisory Board; B-K Medical, F. Consultant/Advisory Board; R.G. Stock, None.
2882
Does Hormone Therapy Exacerbate the Adverse Effects of Radiotherapy in the Treatment of Men with Prostate Cancer? A Quality of Life Study
J. D. Grant, M. S. Litwin, L. Kwan, S. P. Lee, M. L. Steinberg, C. R. King University of California, Los Angeles, Los Angeles, CA Purpose/Objective(s): This study examines whether Androgen Deprivation Therapy (ADT) as an adjunct to radiotherapy impacts health-related quality of life (HRQOL) outcomes in patients with localized prostate cancer treated definitively with either external beam radiation therapy (EBRT) or brachytherapy (BT). Materials/Methods: From 1999 to 2003, patients anticipating treatment for localized prostate cancer were enrolled in a prospective study at UCLA. At defined pre- and post-treatment intervals out to 48 months, participants completed validated tools including the Medical Outcomes Study Short Form-36 (SF-36), the University of California, Los Angeles Prostate Cancer Index (PCI), and the American Urological Association Symptoms Index (AUASI). 81 men were treated with EBRT alone and 67 were treated with EBRT+ADT. 67 patients had EBRT only, 63 had BT monotherapy, and 18 had EBRT+BT. Median ADT duration was 4 months. We compared the time to return to baseline for men who did or did not receive ADT in 6 HRQOL domains: physical and mental composite scores, AUASI, urinary control, sexual function, and bowel function. Univariate and multivariate analysis were performed. Covariates included age, clinical stage, and comorbidities. Results: Multivariate analysis identified factors associated with longer time to return to baseline mental health, including nonwhite race (2 months, p = 0.008), history of stroke (6 months, p \ 0.001) and history of alcohol use (3 months, p = 0.037). Men treated with BT monotherapy experienced longer time to return to baseline for urinary control (PCI, 2.8 months, p = 0.006) and urinary symptoms (AUASI, 7.4 months, p \ 0.001). The time to return to baseline levels in any of the 6 HRQOL domains was not significantly affected by the addition of ADT. Use of erectile dysfunction medications or alpha blockers did not differ between patients receiving ADT or not. Men receiving ADT as an adjunct to radiotherapy had significantly higher-risk prostate cancer. Conclusions: Our study shows that the addition of ADT to definitive radiotherapy does not significantly impact the time to return to baseline scores in 6 patient-reported HRQOL domains. These data may be valuable for patients and physicians when weighing the toxicity and benefits of ADT when added to definitive radiation. Author Disclosure: J.D. Grant, None; M.S. Litwin, None; L. Kwan, None; S.P. Lee, None; M.L. Steinberg, None; C.R. King, None.
2883
A Comparison of the Impact of Isotope on Acute Urinary Toxicity following Interstitial Brachytherapy and External Beam Radiation Therapy for Clinically Localized Prostate Cancer
M. A. Kollmeier, E. Algur, M. Schechter, X. Pei, G. Cohen, Y. Yamada, B. Cox, M. J. Zelefsky Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): To compare acute urinary toxicities associated with combined interstitial brachytherapy and external beam radiation therapy (EBRT) using various isotopes (I-125, Pd-103, or Ir-192) in patients with clinically localized prostate cancer. Materials/Methods: Three hundred forty-six patients who underwent prostate brachytherapy (I-125: n = 199; Pd-103: n = 60; HDR: n = 87) followed by EBRT (median dose 50.4 Gy) between 2002 and 2008 were included. Brachytherapy prescription doses were as follows: I-125, 110 Gy; Pd-103, 100 Gy; Ir-192, median 21 Gy. All patients had baseline and a minimum of 1 year postimplant follow-up with urinary toxicity assessment using CTCAE v 3.0 and IPSS questionnaires (median follow-up, 31 months). Urinary quality of life (QOL) from the IPSS was collected. The mean number of IPSS scores per patient was 4. A post-implant CT was obtained at day 0 for all patients. The median D90 for I-125 and Pd-103 was 111.4 Gy and 107.1 Gy, respectively. A total of 115 (33%) patients received neoadjuvant hormonal therapy. Patient and treatment-related factors were examined for an association with urinary toxicity including prostate volume, use of hormone therapy (HT), pre-implant urinary medication use, isotope type,
S598
Volume 78, Number 3, Supplement, 2010
dysfunction (ED) was measured using the Sexual Health Inventory for Men (SHIM) questionnaire (22-25 = no ED, 17-21 = mild ED, 12-16 = mild to moderate ED, 8-11 = moderate ED, and 1-7 = severe); ED was also graded by the physician-assessed Mount Sinai Erectile Function (MSEF) score (0 = no erectile function, 1 = erections insufficient for intercourse, 2 = erections sufficient for intercourse but suboptimal, and 3 = optimal erections). Multivariate analysis was also performed to take into account HR and total dose delivered (measured in BED). Results: Mean IPSS scores for group 1 at 1 yr, 2 yr, 5 yr, and 7 yr follow-up, were 10.2, 9.4, 7.4, and 7.5, respectively. In comparison, mean IPSS scores for group 2 at 1 yr, 2 yr, 5 yr, and 7 yr follow-up, were 10.2, 9.6, 8.5, and 8.3, respectively. For groups 1 and 2, average changes in SHIM scores were, respectively, -4.0 and -6.6 at 1yr (p = 2, post-treatment scores = \1 were noted, respectively, in 26% and 56% of patients at 1yr; 27% and 47% at 2yr; 35% and 60% at 5yr; and 42% and 64% at 7yr (p \ .001 for all years). Of note, more patients received HR in group 2 than in group 1 (87% vs. 38%, respectively); the median duration of HR was longer for group 2 than group 1 (9 mo vs. 6 mo, respectively). Multivariable analyses identified both treatment group and HR as significant causes of decreases in MSEF at year 1 (p \ 0.001 and p = .001, respectively), but at year 2, only the treatment group was significant and HR was not (p = .005 and p = .191, respectively); at year 5, treatment group remained significant and HR was not (p = .016 and p = .507, respectively). Total dose delivered did not independently predict a decrease in MSEF. Conclusions: Patients receiving BR + EBRT are more likely to experience erectile dysfunction than patients receiving BR alone; HR was also noted to independently predict decreases in ED in the first year after treatment, but was no longer significant after 2 yr follow-up. No differences in urinary symptoms were observed. Author Disclosure: I.E. Friedman, None; K. Forsythe, None; N.N. Stone, Prologics, LLC, E. Ownership Interest; Nihon MediPhysics, F. Consultant/Advisory Board; B-K Medical, F. Consultant/Advisory Board; R.G. Stock, None.
2882
Does Hormone Therapy Exacerbate the Adverse Effects of Radiotherapy in the Treatment of Men with Prostate Cancer? A Quality of Life Study
J. D. Grant, M. S. Litwin, L. Kwan, S. P. Lee, M. L. Steinberg, C. R. King University of California, Los Angeles, Los Angeles, CA Purpose/Objective(s): This study examines whether Androgen Deprivation Therapy (ADT) as an adjunct to radiotherapy impacts health-related quality of life (HRQOL) outcomes in patients with localized prostate cancer treated definitively with either external beam radiation therapy (EBRT) or brachytherapy (BT). Materials/Methods: From 1999 to 2003, patients anticipating treatment for localized prostate cancer were enrolled in a prospective study at UCLA. At defined pre- and post-treatment intervals out to 48 months, participants completed validated tools including the Medical Outcomes Study Short Form-36 (SF-36), the University of California, Los Angeles Prostate Cancer Index (PCI), and the American Urological Association Symptoms Index (AUASI). 81 men were treated with EBRT alone and 67 were treated with EBRT+ADT. 67 patients had EBRT only, 63 had BT monotherapy, and 18 had EBRT+BT. Median ADT duration was 4 months. We compared the time to return to baseline for men who did or did not receive ADT in 6 HRQOL domains: physical and mental composite scores, AUASI, urinary control, sexual function, and bowel function. Univariate and multivariate analysis were performed. Covariates included age, clinical stage, and comorbidities. Results: Multivariate analysis identified factors associated with longer time to return to baseline mental health, including nonwhite race (2 months, p = 0.008), history of stroke (6 months, p \ 0.001) and history of alcohol use (3 months, p = 0.037). Men treated with BT monotherapy experienced longer time to return to baseline for urinary control (PCI, 2.8 months, p = 0.006) and urinary symptoms (AUASI, 7.4 months, p \ 0.001). The time to return to baseline levels in any of the 6 HRQOL domains was not significantly affected by the addition of ADT. Use of erectile dysfunction medications or alpha blockers did not differ between patients receiving ADT or not. Men receiving ADT as an adjunct to radiotherapy had significantly higher-risk prostate cancer. Conclusions: Our study shows that the addition of ADT to definitive radiotherapy does not significantly impact the time to return to baseline scores in 6 patient-reported HRQOL domains. These data may be valuable for patients and physicians when weighing the toxicity and benefits of ADT when added to definitive radiation. Author Disclosure: J.D. Grant, None; M.S. Litwin, None; L. Kwan, None; S.P. Lee, None; M.L. Steinberg, None; C.R. King, None.
2883
A Comparison of the Impact of Isotope on Acute Urinary Toxicity following Interstitial Brachytherapy and External Beam Radiation Therapy for Clinically Localized Prostate Cancer
M. A. Kollmeier, E. Algur, M. Schechter, X. Pei, G. Cohen, Y. Yamada, B. Cox, M. J. Zelefsky Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): To compare acute urinary toxicities associated with combined interstitial brachytherapy and external beam radiation therapy (EBRT) using various isotopes (I-125, Pd-103, or Ir-192) in patients with clinically localized prostate cancer. Materials/Methods: Three hundred forty-six patients who underwent prostate brachytherapy (I-125: n = 199; Pd-103: n = 60; HDR: n = 87) followed by EBRT (median dose 50.4 Gy) between 2002 and 2008 were included. Brachytherapy prescription doses were as follows: I-125, 110 Gy; Pd-103, 100 Gy; Ir-192, median 21 Gy. All patients had baseline and a minimum of 1 year postimplant follow-up with urinary toxicity assessment using CTCAE v 3.0 and IPSS questionnaires (median follow-up, 31 months). Urinary quality of life (QOL) from the IPSS was collected. The mean number of IPSS scores per patient was 4. A post-implant CT was obtained at day 0 for all patients. The median D90 for I-125 and Pd-103 was 111.4 Gy and 107.1 Gy, respectively. A total of 115 (33%) patients received neoadjuvant hormonal therapy. Patient and treatment-related factors were examined for an association with urinary toxicity including prostate volume, use of hormone therapy (HT), pre-implant urinary medication use, isotope type,