Prospective controlled study comparing patient-reported outcomes after daily online adaptive radiotherapy or conventional IGRT in patients with prostate cancer

Abstract

Purpose

To compare patient-reported outcome measures (PROMs) in patients treated either with cone-beam CT (CBCT)-based online adaptive radiotherapy (oART) or with CBCT-guided conventional image guided radiotherapy (IGRT).

Materials and methods

In this prospective study with convenience allocation, patients with localized prostate cancer received 62 Gy/20 fractions using either daily CBCT-based oART or CBCT-guided conventional IGRT. PROMs (EPIC, QLQ-PR25, IPSS, NCI-PRO-CTCAE) were collected at baseline and at end of therapy. Changes in scores and clinically meaningful deterioration, based on established minimal clinically important differences (MCID), were analyzed.

Results

Seventy-four patients were included (oART: 58.1 %; IGRT: 41.9 %). Groups were demographically similar, although the oART group included more patients with high-risk tumors (40.5 % vs. 9.7 %, p = 0.03). Patients after oART tended to experience smaller, although not statistically significant, declines in health-related quality of life (HRQoL) domains compared to IGRT: EPIC urinary summary (−12.15 vs −20.57, p = 0.07), urinary function (−9.53 vs −17.47, p = 0.05), urinary incontinence (−5.47 vs −13.93, p = 0.07) and PR25 urinary symptom (20.0 vs. 27.5, p = 0.06). EPIC bowel function decline was also less pronounced (−12.64 vs. −19.78, p = 0.10). NCI-PRO-CTCAE scores favored oART for reduced urinary urgency (0.95 vs. 1.57, p = 0.02) and fecal incontinence (0.03 vs. 0.71, p = 0.02). Fewer oART patients reached MCID thresholds for urinary (8–21 %) and bowel (20–23 %) deterioration, but these differences were not statistically significant.

Conclusion

Our results suggest a small but consistent trend in PROM scores favoring oART over conventional IGRT. In addition, the results may inform the design of controlled randomized trials in the future.