Long-Term Patient-Reported Bowel and Urinary Quality of Life in Patients Treated with Intensity-Modulated Radiotherapy Versus Intensity-Modulated Proton Therapy for Localized Prostate Cancer
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Selection
2.2. Measurement of Patient-Reported QOL and Treatment Details
2.3. Statistical Analysis
3. Results
3.1. Baseline Demographics and EPIC-26 Questionnaire Completion
3.2. Changes in the BF, UO and UI Scores Between the IMRT and IMPT Cohorts
3.3. Variables Associated with Domain Score Changes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Donovan, J.L.; Hamdy, F.C.; Lane, J.A.; Mason, M.; Metcalfe, C.; Walsh, E.; Blazeby, J.M.; Peters, T.J.; Holding, P.; Bonnington, S.; et al. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N. Engl. J. Med. 2016, 375, 1425–1437. [Google Scholar]
- Whitaker, T.J.; Routman, D.M.; Schultz, H.; Harmsen, W.S.; Corbin, K.S.; Wong, W.W.; Choo, R. IMPT versus VMAT for Pelvic Nodal Irradiation in Prostate Cancer: A Dosimetric Comparison. Int. J. Part. Ther. 2019, 5, 11–23. [Google Scholar] [CrossRef] [PubMed]
- Bryant, C.; Smith, T.L.; Henderson, R.H.; Hoppe, B.S.; Mendenhall, W.M.; Nichols, R.C.; Morris, C.G.; Williams, C.R.; Su, Z.; Li, Z.; et al. Five-Year Biochemical Results, Toxicity, and Patient-Reported Quality of Life After Delivery of Dose-Escalated Image Guided Proton Therapy for Prostate Cancer. Int. J. Radiat. Oncol. Biol. Phys. 2016, 95, 422–434. [Google Scholar] [PubMed]
- Takagi, M.; Demizu, Y.; Terashima, K.; Fujii, O.; Jin, D.; Niwa, Y.; Daimon, T.; Murakami, M.; Fuwa, N.; Okimoto, T. Long-term outcomes in patients treated with proton therapy for localized prostate cancer. Cancer Med. 2017, 6, 2234–2243. [Google Scholar] [PubMed]
- Bai, M.; Gergelis, K.R.; Sir, M.; Whitaker, T.J.; Routman, D.M.; Stish, B.J.; Davis, B.J.; Pisansky, T.M.; Choo, R. Comparing bowel and urinary domains of patient-reported quality of life at the end of and 3 months post radiotherapy between intensity-modulated radiotherapy and proton beam therapy for clinically localized prostate cancer. Cancer Med. 2020, 9, 7925–7934. [Google Scholar]
- Wisdom, A.J.; Yeap, B.Y.; Michalski, J.M.; Horick, N.K.; Zietman, A.L.; Christodouleas, J.P.; Kamran, S.C.; Parikh, R.R.; Vapiwala, N.; Mihalcik, S.; et al. Setting the Stage: Feasibility and Baseline Characteristics in the PARTIQoL Trial Comparing Proton Therapy Versus Intensity Modulated Radiation Therapy for Localized Prostate Cancer. Int. J. Radiat. Oncol. Biol. Phys. 2025, 121, 741–751. [Google Scholar]
- Efstathiou, J.A.; Yeap, B.Y.; Michalski, J.M.; Horick, N.; Zietman, A.L.; Christodouleas, J.P.; Kamran, S.C.; Parikh, R.R.; Vapiwala, N.; Mihalcik, S.A.; et al. Prostate Advanced Radiation Technologies Investigating Quality of Life (PARTIQoL): Phase III Randomized Clinical Trial of Proton Therapy vs. IMRT for Localized Prostate Cancer. Int. J. Radiat. Oncol. Biol. Phys. 2024, 120, S1. [Google Scholar] [CrossRef]
- Bekelman, J.E.; Mitra, N.; Efstathiou, J.; Liao, K.; Sunderland, R.; Yeboa, D.N.; Armstrong, K. Outcomes after intensity-modulated versus conformal radiotherapy in older men with nonmetastatic prostate cancer. Int. J. Radiat. Oncol. Biol. Phys. 2011, 81, e325–e334. [Google Scholar] [CrossRef]
- Sheets, N.C.; Goldin, G.H.; Meyer, A.M.; Wu, Y.; Chang, Y.; Stürmer, T.; Holmes, J.A.; Reeve, B.B.; Godley, P.A.; Carpenter, W.R.; et al. Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer. JAMA 2012, 307, 1611–1620. [Google Scholar]
- Kim, S.; Shen, S.; Moore, D.F.; Shih, W.; Lin, Y.; Li, H.; Dolan, M.; Shao, Y.H.; Lu-Yao, G.L. Late gastrointestinal toxicities following radiation therapy for prostate cancer. Eur. Urol. 2011, 60, 908–916. [Google Scholar] [CrossRef]
- Yu, J.B.; Soulos, P.R.; Herrin, J.; Cramer, L.D.; Potosky, A.L.; Roberts, K.B.; Gross, C.P. Proton versus intensity-modulated radiotherapy for prostate cancer: Patterns of care and early toxicity. J. Natl. Cancer Inst. 2013, 105, 25–32. [Google Scholar] [PubMed]
- Yu, J.B.; DeStephano, D.M.; Jeffers, B.; Horowitz, D.P.; Soulos, P.R.; Gross, C.P.; Cheng, S.K. Updated Analysis of Comparative Toxicity of Proton and Photon Radiation for Prostate Cancer. J. Clin. Oncol. 2024, 42, 1943–1952. [Google Scholar]
- Hoppe, B.S.; Michalski, J.M.; Mendenhall, N.P.; Morris, C.G.; Henderson, R.H.; Nichols, R.C.; Mendenhall, W.M.; Williams, C.R.; Regan, M.M.; Chipman, J.J.; et al. Comparative effectiveness study of patient-reported outcomes after proton therapy or intensity-modulated radiotherapy for prostate cancer. Cancer 2014, 120, 1076–1082. [Google Scholar] [PubMed]
- Gray, P.J.; Paly, J.J.; Yeap, B.Y.; Sanda, M.G.; Sandler, H.M.; Michalski, J.M.; Talcott, J.A.; Coen, J.J.; Hamstra, D.A.; Shipley, W.U.; et al. Patient-reported outcomes after 3-dimensional conformal, intensity-modulated, or proton beam radiotherapy for localized prostate cancer. Cancer 2013, 119, 1729–1735. [Google Scholar]
- NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prostate Cancer V.1.2025. © National Comprehensive Cancer Network, Inc., 2024. All Rights Reserved. Available online: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459 (accessed on 1 April 2025).
- Szymanski, K.M.; Wei, J.T.; Dunn, R.L.; Sanda, M.G. Development and validation of an abbreviated version of the expanded prostate cancer index composite instrument for measuring health-related quality of life among prostate cancer survivors. Urology 2010, 76, 1245–1250. [Google Scholar] [PubMed]
- Norman, G.R.; Sloan, J.A.; Wyrwich, K.W. Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Med. Care 2003, 41, 582–592. [Google Scholar]
- Bruner, D.W.; Pugh, S.L.; Lee, W.R.; Hall, W.A.; Dignam, J.J.; Low, D.; Swanson, G.P.; Shah, A.B.; Malone, S.; Michalski, J.M.; et al. Quality of Life in Patients With Low-Risk Prostate Cancer Treated With Hypofractionated vs Conventional Radiotherapy: A Phase 3 Randomized Clinical Trial. JAMA Oncol. 2019, 5, 664–670. [Google Scholar]
- Sanda, M.G.; Dunn, R.L.; Michalski, J.; Sandler, H.M.; Northouse, L.; Hembroff, L.; Lin, X.; Greenfield, T.K.; Litwin, M.S.; Saigal, C.S.; et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N. Engl. J. Med. 2008, 358, 1250–1261. [Google Scholar]
- Dutz, A.; Agolli, L.; Baumann, M.; Troost, E.G.C.; Krause, M.; Hölscher, T.; Löck, S. Early and late side effects, dosimetric parameters and quality of life after proton beam therapy and IMRT for prostate cancer: A matched-pair analysis. Acta Oncol. 2019, 58, 916–925. [Google Scholar]
- Lee, H.J., Jr.; Macomber, M.W.; Spraker, M.B.; Bowen, S.R.; Hippe, D.S.; Fung, A.; Russell, K.J.; Laramore, G.E.; Rengan, R.; Liao, J.; et al. Early toxicity and patient reported quality-of-life in patients receiving proton therapy for localized prostate cancer: A single institutional review of prospectively recorded outcomes. Radiat. Oncol. 2018, 13, 179. [Google Scholar]
- Pugh, T.J.; Choi, S.; Nogueras-Gonzalaez, G.M.; Nguyen, Q.N.; Mahmood, U.; Frank, S.J.; Mathai, B.; Zhu, X.R.; Sahoo, N.; Gillin, M.; et al. Proton Beam Therapy for Localized Prostate Cancer: Results from a Prospective Quality-of-Life Trial. Int. J. Part. Ther. 2016, 3, 27–36. [Google Scholar] [PubMed]
- Bulman, G.F.; Bhangoo, R.S.; DeWees, T.A.; Petersen, M.M.; Thorpe, C.S.; Wong, W.W.; Rwigema, J.C.M.; Daniels, T.B.; Keole, S.R.; Schild, S.E.; et al. Dose-volume histogram parameters and patient-reported EPIC-Bowel domain in prostate cancer proton therapy. Radiat. Oncol. J. 2021, 39, 122–128. [Google Scholar] [PubMed]
Characteristics | IMRT (n = 82) | IMPT (n = 56) | p-Value * |
---|---|---|---|
Age | |||
Mean (range), year | 70.9 (55–84) | 70.7 (52–88) | 0.77 |
Age group, n (%) | 0.95 | ||
<70 | 33 (40.2%) | 21 (37.5%) | |
70–79 | 46 (56.1%) | 33 (58.9%) | |
≥80 | 3 (3.7%) | 2 (3.6%) | |
Race | |||
Race, n (%) | 1.00 | ||
White | 77 (93.9%) | 53 (94.6%) | |
Others | 3 (3.7%) | 2 (3.6%) | |
Missing | 2 (2.4%) | 1 (1.8%) | |
Pre-RT PSA | |||
Mean (range, ng/mL) | 7.8 (0.2–39.4) | 7.5 (0.2–23.2) | 0.64 |
PSA level, n (%) | 0.30 | ||
<4 | 25 (30.5%) | 11 (19.6%) | |
4–10 | 40 (48.8%) | 34 (60.7%) | |
>10 | 17 (20.7%) | 11 (19.6%) | |
Gleason score | |||
Group, n (%) | 0.63 | ||
≤7 | 68 (82.9%) | 49 (87.5%) | |
>7 | 14 (17.1%) | 7 (12.5%) | |
T stage | |||
Group, n (%) | 0.04 | ||
T1 | 40 (48.8%) | 17 (30.4%) | |
T2 | 42 (51.2%) | 39 (69.6%) | |
Dose-fractionation regimen | |||
n (%) | 0.10 | ||
60 Gy/20 fractions | 35 (42.7%) | 14 (25.0%) | |
70.2 Gy/26 fractions | 39 (47.6%) | 36 (64.3%) | |
78 Gy/39 fractions | 8 (9.8%) | 6 (10.7%) | |
Hydrogel spacer | |||
Treated with hydrogel spacer, n (%) | 35 (42.7%) | 20 (35.7%) | 0.48 |
Androgen deprivation therapy (ADT) | |||
Treated with ADT, n (%) | 64 (78.1%) | 40 (71.4%) | 0.42 |
Baseline bowel score | |||
Mean (range) | 94.0 (62.5–100) | 92.3 (50–100) | 0.98 |
Standard deviation | 8.3 | 12.6 | |
Missing | 3 | 1 | |
Baseline urinary incontinence score | |||
Mean (range) | 87.7 (22.8–99.5) | 88.9 (39.3–99.5) | 0.49 |
Standard deviation | 16.7 | 15.8 | |
Missing | 0 | 1 | |
Baseline urinary irritative/obstructive score | |||
Mean (range) | 85.8 (43.8–100) | 84.4 (50–100) | 0.50 |
Standard deviation | 12.6 | 12.6 | |
Missing | 0 | 5 |
EPIC-26 Domain | Radiation Modality | No. of Respondents (%) | Mean Score Change From Baseline (Range) | p * | Clinically Relevant Change? (Y/N) ** |
---|---|---|---|---|---|
Bowel function | IMRT | 76 (92.7%) | −4.52 (−50, 29.17) | 0.003 | Y |
IMPT | 54 (96.4%) | −1.88 (−37.5, 50) | 0.046 | N | |
Urinary incontinence | IMRT | 67 (81.7%) | −2.61 (−32.75, 27.5) | 0.79 | N |
IMPT | 51 (91.1%) | −0.80 (−39, 40) | 0.75 | N | |
Urinary irritative/obstructive | IMRT | 76 (92.7%) | −0.58 (−50, 25) | 0.76 | N |
IMPT | 51 (91.1%) | 1.84 (−37.5, 43.75) | 0.41 | N |
EPIC-26 Domain | Radiation Modality | Patients with Clinically Relevant Reduction (%) | p * |
---|---|---|---|
Bowel | |||
IMRT | 36 (47.4%) | 0.017 | |
IMPT | 14 (25.9%) | ||
Urinary Incontinence | |||
IMRT | 15 (22.4%) | 0.82 | |
IMPT | 10 (19.6%) | ||
Urinary Irritative/Obstructive | |||
IMRT | 12 (15.8%) | 0.36 | |
IMPT | 12 (23.5%) |
EPIC-26 Domain | Radiation Modality | Late Response | |
---|---|---|---|
Mean Change from Baseline | p * | ||
Bowel | |||
IMRT | −4.52 | 0.69 | |
IMPT | −1.88 | ||
Urinary Incontinence | |||
IMRT | −2.61 | 0.55 | |
IMPT | −0.80 | ||
Urinary Irritative/Obstructive | |||
IMRT | −0.58 | 0.64 | |
IMPT | 1.84 |
EPIC-26 Domain | Independent Variable | Coefficient | p-Value * |
---|---|---|---|
Bowel | Baseline BF score | −0.9 | <0.001 |
Baseline UO score | 0.2 | 0.01 | |
Urinary incontinence | Baseline UI score | −0.4 | <0.001 |
Urinary irritative/obstructive | Baseline UO score | −0.7 | <0.001 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Gergelis, K.R.; Bai, M.; Ma, J.; Routman, D.M.; Stish, B.J.; Davis, B.J.; Pisansky, T.M.; Whitaker, T.J.; Choo, R. Long-Term Patient-Reported Bowel and Urinary Quality of Life in Patients Treated with Intensity-Modulated Radiotherapy Versus Intensity-Modulated Proton Therapy for Localized Prostate Cancer. Curr. Oncol. 2025, 32, 212. https://doi.org/10.3390/curroncol32040212
Gergelis KR, Bai M, Ma J, Routman DM, Stish BJ, Davis BJ, Pisansky TM, Whitaker TJ, Choo R. Long-Term Patient-Reported Bowel and Urinary Quality of Life in Patients Treated with Intensity-Modulated Radiotherapy Versus Intensity-Modulated Proton Therapy for Localized Prostate Cancer. Current Oncology. 2025; 32(4):212. https://doi.org/10.3390/curroncol32040212
Chicago/Turabian StyleGergelis, Kimberly R., Miao Bai, Jiasen Ma, David M. Routman, Bradley J. Stish, Brian J. Davis, Thomas M. Pisansky, Thomas J. Whitaker, and Richard Choo. 2025. "Long-Term Patient-Reported Bowel and Urinary Quality of Life in Patients Treated with Intensity-Modulated Radiotherapy Versus Intensity-Modulated Proton Therapy for Localized Prostate Cancer" Current Oncology 32, no. 4: 212. https://doi.org/10.3390/curroncol32040212
APA StyleGergelis, K. R., Bai, M., Ma, J., Routman, D. M., Stish, B. J., Davis, B. J., Pisansky, T. M., Whitaker, T. J., & Choo, R. (2025). Long-Term Patient-Reported Bowel and Urinary Quality of Life in Patients Treated with Intensity-Modulated Radiotherapy Versus Intensity-Modulated Proton Therapy for Localized Prostate Cancer. Current Oncology, 32(4), 212. https://doi.org/10.3390/curroncol32040212