Author:
Joseph Nuradh,Cicchetti Alessandro,McWilliam Alan,Webb Adam,Seibold Petra,Fiorino Claudio,Cozzarini Cesare,Veldeman Liv,Bultijnck Renée,Fonteyne Valérie,Talbot Christopher J.,Symonds Paul R.,Johnson Kerstie,Rattay Tim,Lambrecht Maarten,Haustermans Karin,De Meerleer Gert,Elliott Rebecca M.,Sperk Elena,Herskind Carsten,Veldwijk Marlon,Avuzzi Barbara,Giandini Tommaso,Valdagni Riccardo,Azria David,Jacquet Marie-Pierre Farcy,Charissoux Marie,Vega Ana,Aguado-Barrera Miguel E.,Gómez-Caamaño Antonio,Franco Pierfrancesco,Garibaldi Elisabetta,Girelli Giuseppe,Iotti Cinzia,Vavassori Vittotorio,Chang-Claude Jenny,West Catharine M. L.,Rancati Tiziana,Choudhury Ananya
Abstract
IntroductionWe hypothesized that increasing the pelvic integral dose (ID) and a higher dose per fraction correlate with worsening fatigue and functional outcomes in localized prostate cancer (PCa) patients treated with external beam radiotherapy (EBRT).MethodsThe study design was a retrospective analysis of two prospective observational cohorts, REQUITE (development, n=543) and DUE-01 (validation, n=228). Data were available for comorbidities, medication, androgen deprivation therapy, previous surgeries, smoking, age, and body mass index. The ID was calculated as the product of the mean body dose and body volume. The weekly ID accounted for differences in fractionation. The worsening (end of radiotherapy versus baseline) of European Organisation for Research and Treatment of Cancer EORTC) Quality of Life Questionnaire (QLQ)-C30 scores in physical/role/social functioning and fatigue symptom scales were evaluated, and two outcome measures were defined as worsening in ≥2 (WS2) or ≥3 (WS3) scales, respectively. The weekly ID and clinical risk factors were tested in multivariable logistic regression analysis.ResultsIn REQUITE, WS2 was seen in 28% and WS3 in 16% of patients. The median weekly ID was 13.1 L·Gy/week [interquartile (IQ) range 10.2-19.3]. The weekly ID, diabetes, the use of intensity-modulated radiotherapy, and the dose per fraction were significantly associated with WS2 [AUC (area under the receiver operating characteristics curve) =0.59; 95% CI 0.55-0.63] and WS3 (AUC=0.60; 95% CI 0.55-0.64). The prevalence of WS2 (15.3%) and WS3 (6.1%) was lower in DUE-01, but the median weekly ID was higher (15.8 L·Gy/week; IQ range 13.2-19.3). The model for WS2 was validated with reduced discrimination (AUC=0.52 95% CI 0.47-0.61), The AUC for WS3 was 0.58,ConclusionIncreasing the weekly ID and the dose per fraction lead to the worsening of fatigue and functional outcomes in patients with localized PCa treated with EBRT.
Funder
Seventh Framework Programme
Associazione Italiana per la Ricerca sul Cancro
Cited by
1 articles.
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