Fecal incontinence after moderately hypofractionated volumetric modulated arc therapy for prostate cancer: incidence and impact on quality of life.

Purpose: Fecal incontinence (FI) is a late toxicity consequence in prostate cancer patients treated with current radiotherapy schedules that remains poorly described and understood. The main objective of this work is to describe the incidence of appearance of FI in these patients, and to analyze whether this late radiotoxicity event affects the quality of life of survivors.

Methods: Prospective follow-up study was performed on a cohort of 91 patients with non-metastatic prostate cancer undergoing moderately hypofractionated volumetric modulated arc therapy (VMAT at 2.5-3 Gy/session) with image-guided radiotherapy (IGRT) in a real-world clinical practice scenario. The incidence of FI (using the Vaizey score) and FI-free survival time after completion of radiotherapy were presented. We additionally assessed the scores on the FI Quality of Life (FIQL) scale in both patients with and without FI.

Results: Within 2 years after radiotherapy, 10 of 91 patients (11%) showed some degree of FI with an average onset at 13.59 months. Patients with some degree of FI had worse FIQL scores than those without FI (p < 0.001).

Conclusion: Patients with localized prostate cancer treated with moderately hypofractionated VMAT/IGRT had a significant incidence of fecal incontinence, which negatively affected the quality of life of survivors.

Trial registry: The study protocol was registered on clinicaltrials.gov (NCT04262609) on 5 February 2020.