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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]