Genitourinary Cancer

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SU_31_2315 - Tumor Control and Quality of Life up to 10 Years after Radiation Therapy for Prostate Cancer

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Tumor Control and Quality of Life up to 10 Years after Radiation Therapy for Prostate Cancer
M. Pinkawa1,2, A. Gharib2, V. Berneking1,2, M. Schlenter2, and M. J. Eble2; 1Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany, 2Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany

Purpose/Objective(s): The aim of the study was the analysis of tumor control and long-term quality of life (QoL) changes after radiotherapy (RT) with a specific focus on the impact of fraction/total dose.

Materials/Methods: A group of 382 prostate cancer patients was treated in the years 2003-2006 with a three-dimensional conformal four-field box technique in a single institution. The concept included a moderate consecutive dose escalation from 70.2Gy in 1.8Gy fractions (n=206) to 72Gy in 1.8-2.0Gy fractions (n=176). Patients were surveyed using the EPIC (Expanded Prostate Cancer Index Composite) questionnaire before the beginning of RT, at the last day of RT, two months, 1-2 years, 5-6 years and 9-12 years after the end of RT (minimum changes of 5 points regarded as clinically significant).

Results: Biochemical tumor control in the 72Gy subgroup was significantly higher in comparision to the 70.2Gy subgroup (78% vs. 55% after 10 years; p<0.01) – including subgroup analyses for intermediate (80% vs. 58%; p< 0.01) and high risk patients (60% vs. 35%; p< 0.01). Improved prostate cancer specific (83% vs. 58% after 10 years; p=0.02) and overall survival (67% vs. 42% after 10 years; p=0.03) resulted with a higher total dose for patients with a Gleason score ≥7. Urinary and bowel bother scores decreased 1 / 3 / 6 points and 7 / 7 / 9 points on average 1 / 5 / 10 years after RT in comparison to baseline scores. The rate of urinary (need of pads in 8% vs. 15% before vs. 10 years after RT; p=0.01) and bowel (uncontrolled leakage of stool in 5% vs. 12% before vs. 10 years after RT; p<0.01) incontinence, as well as rectal bleeding (4% vs. 8% before vs. 10 years after RT; p=0.05) increased. In the 72Gy group, the difference after 5 years was significantly larger in comparison to 70.2Gy (urinary bother: 6 vs. -1; p=0.02; bowel bother: 9 vs. 4; p=0.04). Sexual function scores decreased 6, 13 and 18 points in the corresponding intervals (erections sufficient for intercourse in 36% vs. 12% before vs. 10 years after RT; p<0,01). For patients with moderate/big problems with urinary function overall at the last day of RT, similar urinary score changes were found during the following years as for patients without or with only small problems. In contrast, patients with moderate/big problems with bowel habits at the last day of RT had significantly larger bowel bother score changes even many years after treatment in comparison to patients without or with small problems (decrease of 23 vs. 6 points 10 years after RT; p< 0.01).

Conclusion: The apparently minor dose escalation from 70.2Gy to 72Gy with escalation of dose per fraction was found to be clinically relevant for biochemical tumor control, even overall survival, urinary and bowel problems. Apart from an increasing rate of erectile dysfunction, urinary and bowel incontinence rates increased. Acute bowel problems during radiotherapy had a considerable consecutive component, relevant even 10 years later.

Author Disclosure: M. Pinkawa: None. A. Gharib: None. V. Berneking: None.

Michael Pinkawa, MD, PhD

MediClin Robert Janker Klinik

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