Toxicity of pelvic lymph node irradiation with intensity modulated radiation therapy for high-risk and locally advanced prostate cancer: a national population-based study using patient-reported outcomes
AuthorsParry, M. G.
Cowling, T. E.
Clarke, Noel W
van der Meulen, J.
AffiliationDepartment of Health Services Research and Policy, London School of Hygiene and Tropical Medicine; Clinical Effectiveness Unit, Royal College of Surgeons of England
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AbstractPurpose: Little is known about the toxicity of additional pelvic lymph node irradiation in men receiving intensity-modulated radiotherapy (IMRT) for prostate cancer. The aim of this study was to compare patient-reported outcomes following IMRT to the prostate only (PO-IMRT) versus the prostate and pelvic lymph nodes (PPLN-IMRT). Methods and materials: Patients diagnosed with high-risk or locally advanced prostate cancer in the English National Health Service between April 2014 and September 2016 treated with IMRT were mailed a questionnaire at least 18 months after diagnosis. Patient-reported urinary, sexual, bowel and hormonal functional domains on a scale from 0 to 100 with higher scores indicating better outcomes and generic health-related quality of life were collected using the EPIC-26 and EQ-5D-5L. We used linear regression to compare PPLN-IMRT versus PO-IMRT with adjustment for patient, tumour and treatment characteristics. Results: Of the 7017 men who received a questionnaire, 5468 (77.9%) responded with 4196 (76.7%) having received PO-IMRT and 1272 (23.3%) PPLN-IMRT. Adjusted differences in EPIC-26 domain scores were smaller than 1 (p always >0.2) except for sexual function with men who had PPNL-IMRT reporting a lower mean score (adjusted difference 2.3, 95% confidence interval 0.9 to 3.7; p=0.002), which did not represent a clinically relevant difference. There was no significant difference in HRQoL (p=0.5). Conclusions: Additional pelvic lymph node irradiation does not lead to clinically meaningful increases in the toxicity of IMRT for prostate cancer according to patient-reported functional outcomes and HRQoL. Keywords: Prostate cancer; intensity-modulated radiotherapy; patient-reported outcomes measures; pelvic lymph nodes.
CitationParry MG, Nossiter J, Cowling TE, Sujenthiran A, Berry B, Cathcart P, et al. Toxicity of pelvic lymph node irradiation with intensity modulated radiation therapy for high-risk and locally advanced prostate cancer: a national population-based study using patient-reported outcomes. Int J Radiat Oncol Biol Phys. 2020.
JournalInternational Journal of Radiation Oncology Biology Physics
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