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    High weekly integral dose and larger fraction size increase risk of fatigue and worsening of functional outcomes following radiotherapy for localized prostate cancer

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    Authors
    Joseph, N.
    Cicchetti, A.
    McWilliam, A.
    Webb, A.
    Seibold, P.
    Fiorino, C.
    Cozzarini, C.
    Veldeman, L.
    Bultijnck, R.
    Fonteyne, V.
    Talbot, C. J.
    Symonds, P. R.
    Johnson, K.
    Rattay, T.
    Lambrecht, M.
    Haustermans, K.
    De Meerleer, G.
    Elliott, Rebecca M
    Sperk, E.
    Herskind, C.
    Veldwijk, M.
    Avuzzi, B.
    Giandini, T.
    Valdagni, R.
    Azria, D.
    Jacquet, M. F.
    Charissoux, M.
    Vega, A.
    Aguado-Barrera, M. E.
    Gómez-Caamaño, A.
    Franco, P.
    Garibaldi, E.
    Girelli, G.
    Iotti, C.
    Vavassori, V.
    Chang-Claude, J.
    West, C. M. L.
    Rancati, T.
    Choudhury, A.
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    Affiliation
    Department of Clinical Oncology, District General Hambantota, Hambantota, Sri Lanka
    Issue Date
    2022
    
    Metadata
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    Abstract
    Introduction: We hypothesized that increasing the pelvic integral dose (ID) and a higher dose per fraction correlate with worsening fatigue and functional outcomes in localized prostate cancer (PCa) patients treated with external beam radiotherapy (EBRT). Methods: The study design was a retrospective analysis of two prospective observational cohorts, REQUITE (development, n=543) and DUE-01 (validation, n=228). Data were available for comorbidities, medication, androgen deprivation therapy, previous surgeries, smoking, age, and body mass index. The ID was calculated as the product of the mean body dose and body volume. The weekly ID accounted for differences in fractionation. The worsening (end of radiotherapy versus baseline) of European Organisation for Research and Treatment of Cancer EORTC) Quality of Life Questionnaire (QLQ)-C30 scores in physical/role/social functioning and fatigue symptom scales were evaluated, and two outcome measures were defined as worsening in ≥2 (WS2) or ≥3 (WS3) scales, respectively. The weekly ID and clinical risk factors were tested in multivariable logistic regression analysis. Results: In REQUITE, WS2 was seen in 28% and WS3 in 16% of patients. The median weekly ID was 13.1 L·Gy/week [interquartile (IQ) range 10.2-19.3]. The weekly ID, diabetes, the use of intensity-modulated radiotherapy, and the dose per fraction were significantly associated with WS2 [AUC (area under the receiver operating characteristics curve) =0.59; 95% CI 0.55-0.63] and WS3 (AUC=0.60; 95% CI 0.55-0.64). The prevalence of WS2 (15.3%) and WS3 (6.1%) was lower in DUE-01, but the median weekly ID was higher (15.8 L·Gy/week; IQ range 13.2-19.3). The model for WS2 was validated with reduced discrimination (AUC=0.52 95% CI 0.47-0.61), The AUC for WS3 was 0.58. Conclusion: Increasing the weekly ID and the dose per fraction lead to the worsening of fatigue and functional outcomes in patients with localized PCa treated with EBRT
    Citation
    Joseph N, Cicchetti A, McWilliam A, Webb A, Seibold P, Fiorino C, et al. High weekly integral dose and larger fraction size increase risk of fatigue and worsening of functional outcomes following radiotherapy for localized prostate cancer. Frontiers in oncology. 2022;12:937934. PubMed PMID: 36387203. Pubmed Central PMCID: PMC9645430. Epub 2022/11/18. eng.
    Journal
    Frontiers in Oncology
    URI
    http://hdl.handle.net/10541/625854
    DOI
    10.3389/fonc.2022.937934
    PubMed ID
    36387203
    Additional Links
    https://dx.doi.org/10.3389/fonc.2022.937934
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.3389/fonc.2022.937934
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