Impact of treatment and clinical factors on worsening of functional scales after prostate cancer RT
Cicchetti, A. Joseph, N. Choudhury, Ananya Avuzzi, B. Valdagni, R. Rancati, T. Seibold, P. Chang-Claude, J. Azria, D. Vega, A.
Cicchetti, A.
Joseph, N.
Choudhury, Ananya
Avuzzi, B.
Valdagni, R.
Rancati, T.
Seibold, P.
Chang-Claude, J.
Azria, D.
Vega, A.
Citations
Altmetric:
Abstract
Purpose or Objective
The study aimed to evaluate the deterioration of functional outcomes in localized prostate cancer (PCa)
patients (pts) treated with external beam radiotherapy (RT) with a focus on oncological treatment and patient
features.
Materials and Methods
EORTC QLQ-C30 (version 3.0) was administered to pts enrolled in a multicenter prospective observational
study. For this analysis, we specifically considered one symptom scale (Fatigue) and three functional scales
(Physical, Role, Social) at three time-points: baseline, RT end and 2-year after RT. The average score variation
in acute and late phases as stratified by treatment and patient factors was determined. We used radar plots
to report results quantitatively, and we computed the hexagonal areas from these plots to obtain a summary
variable describing the functional status. Worsening in at least 2 (wrs2) or 3 (wrs3) scales were considered as
additional endpoints, with cut-offs for clinically significant deterioration defined as suggested by Cooks et al.
(EJC 2012).
Results
A total of 1143 pts with complete information were available. Among treatment features, we considered:
prostatectomy, pelvic irradiation (LN), hormone-therapy and fractionation (2-2.65 Gy/fr vs 2.7-3.4 Gy/fr). We
explored age, diabetes and urinary symptoms at baseline as patient characteristics.
Figure 1 shows a panel of radar plots with scores for the different scales. Table 1 reports hexagonal areas and
the prevalence of wrs2/wrs3 as a function of investigated characteristics and time-points. The Ratio of the
hexagonal regions “(at RT end)/(at 2-year)” is reported as an index for the recovery of acute effects.
Diabetes slows down the impact of RT on functional and symptom scales with a continuous deterioration at 2-
year (Ratio=0.85), which is characterized by the best incidence of wrs2 and 3 post-RT and worst incidences in
the late phase.
Moderate hypofractionation strongly affects the acute phase (Area, wrs2 and 3 incidences), showing at the
same time the best recovery index at 2-year.
Age does not affect the acute phase but takes part in the recovery capability. Patients who underwent
prostatectomy are no more affected by the treatment, probably, because of the long lapse of time between
surgery and RT (average time 2.7 year). Small differences are found between patients irradiated or not to LN.
As a potential explanation we could mention the difference in the average dose/fraction for patients with and
without LN irradiation, 2.00 Gy/fr vs 2.3 Gy/fr, respectively. Finally, Area of pts with and without urinary
dysfunctions are well-differentiated only at 2-year, while it is the opposite with hormone-therapy treatment. Conclusion
Results from the EORTC QLQ-C30 highlighted a large variability in the deterioration of functional and symptom
scales with time. Moderate hypofractionation impacts the QoL acute perception of prostate cancer patients,
while diabetes strongly affects the late phase after a better acute condition than the other analyzed
characteristics.
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Cicchetti A, Joseph N, Choudhury A, Avuzzi B, Valdagni R, Rancati T, et al. Impact of treatment and clinical factors on worsening of functional scales after prostate cancer RT. Radiotherapy and Oncology. 2021;161:S596-S8.