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Patient-reported Urinary, Bowel, and Sexual Function After Hypofractionated Intensity-modulated Radiation Therapy for Prostate Cancer: Results From a Randomized Trial

Hoffman, Karen, E., MD, MPH, MHSc; Skinner, Heath, MD, PhD; Pugh, Thomas, J., MD; Voong, Khinh, R., MD; Levy, Lawrence, B., MS; Choi, Seungtaek, MD; Frank, Steven, J., MD; Lee, Andrew, K., MD; Mahmood, Usama, MD; McGuire, Sean, E., MD, PhD; Schlembach, Pamela, J., MD; Du, Weiliang, PhD; Johnson, Jennifer, MS, MBA; Kudchadker, Rajat, J., PhD; Kuban, Deborah, A., MD

American Journal of Clinical Oncology: June 2018 - Volume 41 - Issue 6 - p 558–567
doi: 10.1097/COC.0000000000000325
Original Articles: Genitourinary

Objectives: Hypofractionated prostate radiotherapy may increase biologically effective dose delivered while shortening treatment duration, but information on patient-reported urinary, bowel, and sexual function after dose-escalated hypofractionated radiotherapy is limited. We report patient-reported outcomes (PROs) from a randomized trial comparing hypofractionated and conventional prostate radiotherapy.

Methods: Men with localized prostate cancer were enrolled in a trial that randomized men to either conventionally fractionated intensity-modulated radiation therapy (CIMRT, 75.6 Gy in 1.8 Gy fractions) or to dose-escalated hypofractionated IMRT (HIMRT, 72 Gy in 2.4 Gy fractions). Questionnaires assessing urinary, bowel, and sexual function were completed pretreatment and at 2, 3, 4, and 5 years after treatment.

Results: Of 203 eligible patients, 185 were evaluable for PROs. A total of 173 completed the pretreatment questionnaire (82 CIMRT, 91 HIMRT) and 102 completed the 2-year questionnaire (46 CIMRT, 56 HIMRT). Patients who completed PROs were similar to those who did not complete PROs (all P>0.05). Patient characteristics, clinical characteristics, and baseline symptoms were well balanced between the treatment arms (all P>0.05). There was no difference in patient-reported bowel (urgency, control, frequency, or blood per rectum), urinary (dysuria, hematuria, nocturia, leakage), or sexual symptoms (erections firm enough for intercourse) between treatment arms at 2, 3, 4, and 5 years after treatment (all P>0.01). Concordance between physician-assessed toxicity and PROs varied across urinary and bowel domains.

Discussion: We did not detect an increase in patient-reported urinary, bowel, and sexual symptom burden after dose-escalated intensity-modulated prostate radiation therapy using a moderate hypofractionation regimen (72 Gy in 2.4 Gy fractions) compared with conventionally fractionated radiation.

Departments of Radiation Oncology and Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX

The authors declare no conflicts of interest.

Reprints: Karen E. Hoffman, MD, MPH, MHSc, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1202, Houston, TX 77030. E-mail:

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