Download Partial Breast Irradiation Using Proton Therapy: A Pilot Study

Multi-institutional Prospective Quality of
Life Outcomes in Patients Treated with
Proton Therapy for Prostate Cancer
Andrew L. Chang, MD 張維安
Radiation Oncologist
[email protected]
Introduction
• Prostate Cancer is the most common cancer among US men
• There a wide variety of treatment modalities that have excellent
control rates
– The focus of treatment now revolves are side effect profiles
• Over the past 20 years, proton beam radiation therapy has been
used very successfully as an external beam radiotherapy modality
for cancer control
• There remain questions about the clinical benefit of proton therapy
compared with other treatment modalities
• The Expanded Prostate Cancer Index Composite (EPIC) is a quality
of life survey used for patients with prostate cancer and validated in
men who have undergone surgery or radiotherapy without or
without androgen suppression
– It measures 4 umbrella domains: Urinary function, bowel habits,
sexual function, and hormonal function
Introduction
• The University of Florida recently published their
results of patient reported quality of life measures with
EPIC of proton therapy for the treatment of prostate
cancer (Hoppe, et al. Cancer 2013)
– They had ~1200 men who had undergone proton radiation
treatment with evaluable EPIC scores
– There was a corresponding cohort of ~200 men who had
undergone IMRT for prostate cancer that likewise had
patient report QoL with EPIC
– No differences were seen in summary score changes
– There was the suggestion of worsened bowel frequency
and urgency in men in the IMRT cohort
Introduction
•
Hoppe, et al. Cancer 2013
Methods
• Proton Collaborative Group (PCG) is a clinical trials group that
focuses on running multi-institutional particle therapy studies
– PCG has several studies that enroll prostate cancer patients
– 3 Clinical Therapeutic trials
•
•
•
•
Low risk: randomized 44 x 1.8 Gy vs. 5 x 7.0 Gy
Intermediate risk: p+ 28 x 2.5 Gy & randomized to +/- ADT
High risk: p+ 44 x 1.8 Gy randomized to +/- docetaxel (closed)
Registry trial: all pts not on therapeutic trials
– As part of the treatment evaluation, patients complete the full
50-question EPIC
• This was obtained at baseline, and post-RT at 3, 6, 12, 18, 24 months,
and annual thereafter
• With a multi-institutional database of over 1000 men
treated for prostate cancer with proton therapy, we
initiated a study to evaluate the quality of life to see if the
excellent results seen in the single institution UF study
were seen more broadly
Methods
• PCG database had a total of 1236 patients
with a diagnosis of prostate cancer
– With the heterogeneity of treatment regimens of
patients treated on the 3 therapeutic trials, and
the small number of patients that comprised that
group, only patients on the registry were
evaluated
– A minimum follow-up of 18 months was required
for evaluation
Results
• 435 patients were identified who met the criteria
– EPIC scores as baseline, 1-year post-radiation, and
2-year post-radiation were analyzed.
• Patients with missing 1-year EPIC scores had 18-month
post-radiation EPIC scores utilized as 1-year posttreatment scores
EPIC domain
Baseline
1-year post
2-year post
Urinary
89.25
86.68
88.88
Bowel
94.33
89.71
89.29
Sexual
54.90
45.50
67.30
Hormone
91.07
88.56
79.55
• Urinary incontinence pad usage remained unchanged
from 2.6% pre-treatment, to 2.2% at 2 years post-RT
Summary
• Patients report excellent quality of life at one- and twoyears post-proton radiotherapy as measured by EPIC
– While urinary scores remain largely unchanged, there was
a slight decrease in bowel summary scores
– This correlates with the UF finding of a decrease in bowel
summary scores in both IMRT and proton therapy
• Detailed analysis of patient specific factors is being
undertaken to determine correlation of changes to
patients specific factors such as risk category of patient
and androgen deprivation therapy usage
• More follow-up needed to determine if the findings
will continue to hold up
Thank you! Questions?
Andrew L. Chang, MD 張維安
[email protected]