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Re: Long-Term Quality of Life Outcome After Proton Beam Monotherapy for Localized Prostate Cancer
PROSTATE CANCER
909
Re: Long-Term Quality of Life Outcome After Proton Beam Monotherapy for Localized Prostate Cancer J. J. Coen, J. J. Paly, A. Niemierko, E. Weyman, A. Rodrigues, W. U. Shipley, A. L. Zietman and J. A. Talcott Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts Int J Radiat Oncol Biol Phys 2011; Epub ahead of print.
Objectives: High-dose external radiation for localized prostate cancer results in favorable clinical outcomes and low toxicity rates. Here, we report long-term quality of life (QOL) outcome for men treated with conformal protons. Methods: QOL questionnaires were sent at specified intervals to 95 men who received proton radiation. Of these, 87 men reported 3- and/or 12-month outcomes, whereas 73 also reported long-term outcomes (minimum 2 years). Symptom scores were calculated at baseline, 3 months, 12 months, and long-term follow-up. Generalized estimating equation models were constructed to assess longitudinal outcomes while accounting for correlation among repeated measures in an individual patient. Men were stratified into functional groups from their baseline questionnaires (normal, intermediate, or poor function) for each symptom domain. Long-term QOL changes were assessed overall and within functional groups using the Wilcoxon signed-rank test. Results: Statistically significant changes in all four symptom scores were observed in the longitudinal analysis. For the 73 men reporting long-term outcomes, there were significant change scores for incontinence (ID), bowel (BD) and sexual dysfunction (SD), but not obstructive/irritative voiding dysfunction (OID). When stratified by baseline functional category, only men with normal function had increased scores for ID and BD. For SD, there were significant changes in men with both normal and intermediate function, but not poor function. Conclusions: Patient reported outcomes are sensitive indicators of treatment-related morbidity. These results quantitate the long-term consequences of proton monotherapy for prostate cancer. Analysis by baseline functional category provides an individualized prediction of long-term QOL scores. High dose proton radiation was associated with small increases in bowel dysfunction and incontinence, with more pronounced changes in sexual dysfunction. Editorial Comment: Based on what they read, many patients believe that the most effective way to be treated for prostate cancer is proton beam radiotherapy. Indeed, many patients are led to believe that there are no side effects. As a result of this enthusiasm and because of the potential for lucrative facility fees, many of these centers costing more than $150 million are under development in the United States. However, this is the first study which critically evaluates side effects. I found it interesting that although both the Massachusetts General Hospital and Loma Linda University Medical Center enrolled patients in this study, the quality of life component was only performed at the Massachusetts General Hospital. Loma Linda was the first center in the United States to use this form of treatment and is the center which has consistently sung its praises. However, they have published little about their own results. In this report the authors state, “this study demonstrated measurable changes in all four symptom indices: urinary incontinence, urinary obstruction/irritation, bowel function, and sexual function. The mean change in sexual function was most prominent whereas the change in other scores was less so. Overall, proton radiation is well tolerated as measured using a quality of life tool, carrying only a low risk of late urinary or bowel symptomatology but a higher risk of sexual dysfunction.” In this study in men who had normal sexual function before treatment it remained normal in only 28% and in 21% it was categorized as poor. Patrick C. Walsh, M.D.
909
Re: Long-Term Quality of Life Outcome After Proton Beam Monotherapy for Localized Prostate Cancer J. J. Coen, J. J. Paly, A. Niemierko, E. Weyman, A. Rodrigues, W. U. Shipley, A. L. Zietman and J. A. Talcott Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts Int J Radiat Oncol Biol Phys 2011; Epub ahead of print.
Objectives: High-dose external radiation for localized prostate cancer results in favorable clinical outcomes and low toxicity rates. Here, we report long-term quality of life (QOL) outcome for men treated with conformal protons. Methods: QOL questionnaires were sent at specified intervals to 95 men who received proton radiation. Of these, 87 men reported 3- and/or 12-month outcomes, whereas 73 also reported long-term outcomes (minimum 2 years). Symptom scores were calculated at baseline, 3 months, 12 months, and long-term follow-up. Generalized estimating equation models were constructed to assess longitudinal outcomes while accounting for correlation among repeated measures in an individual patient. Men were stratified into functional groups from their baseline questionnaires (normal, intermediate, or poor function) for each symptom domain. Long-term QOL changes were assessed overall and within functional groups using the Wilcoxon signed-rank test. Results: Statistically significant changes in all four symptom scores were observed in the longitudinal analysis. For the 73 men reporting long-term outcomes, there were significant change scores for incontinence (ID), bowel (BD) and sexual dysfunction (SD), but not obstructive/irritative voiding dysfunction (OID). When stratified by baseline functional category, only men with normal function had increased scores for ID and BD. For SD, there were significant changes in men with both normal and intermediate function, but not poor function. Conclusions: Patient reported outcomes are sensitive indicators of treatment-related morbidity. These results quantitate the long-term consequences of proton monotherapy for prostate cancer. Analysis by baseline functional category provides an individualized prediction of long-term QOL scores. High dose proton radiation was associated with small increases in bowel dysfunction and incontinence, with more pronounced changes in sexual dysfunction. Editorial Comment: Based on what they read, many patients believe that the most effective way to be treated for prostate cancer is proton beam radiotherapy. Indeed, many patients are led to believe that there are no side effects. As a result of this enthusiasm and because of the potential for lucrative facility fees, many of these centers costing more than $150 million are under development in the United States. However, this is the first study which critically evaluates side effects. I found it interesting that although both the Massachusetts General Hospital and Loma Linda University Medical Center enrolled patients in this study, the quality of life component was only performed at the Massachusetts General Hospital. Loma Linda was the first center in the United States to use this form of treatment and is the center which has consistently sung its praises. However, they have published little about their own results. In this report the authors state, “this study demonstrated measurable changes in all four symptom indices: urinary incontinence, urinary obstruction/irritation, bowel function, and sexual function. The mean change in sexual function was most prominent whereas the change in other scores was less so. Overall, proton radiation is well tolerated as measured using a quality of life tool, carrying only a low risk of late urinary or bowel symptomatology but a higher risk of sexual dysfunction.” In this study in men who had normal sexual function before treatment it remained normal in only 28% and in 21% it was categorized as poor. Patrick C. Walsh, M.D.