Ultra-hypofractionation radiotherapy has comparable results to conventionally fractioned radiotherapy when it comes to patient-reported quality of life (QOL) in patients with localized prostate cancer, according to a recent article published in The Lancet Oncology (2021;11;S1470-2045[20]30581-7. doi:10.1016/S1470-2045[20]30581-7.)
Per Fransson, PhD, department of nursing, Umeå University (Umeå, Sweden), and colleagues conducted a trial comparing conventionally fractioned radiotherapy with ultra-hypofractionated radiotherapy for patients with intermediate-to-high-risk prostate cancer, aiming to assess patient-reported QOL 6 years after treatment.
Between July 1, 2005, and November 4, 2015, 1600 patients were enrolled in this QOL analysis. Patients included were those up to 75 years of age and who had a WHO Performance Status of 0-2. Participants were randomly assigned conventional fractionation or ultra-hypofractionation (582 vs 583).
One hundred and fifty-eight (71%) of 223 patients in the conventional fractionation group and 146 (66%) of 220 in the ultra-hypofractionation group completed questionnaires 6 years after radiotherapy. QOL was measured using the validated Prostate Cancer Symptom Scale and European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire.
At the end of radiotherapy, patients in the ultra-hypofractionation group faced more problems in seven of ten bowel symptoms than patients in the conventional fractionation group. The study reports: stool frequency (P <.001), rush to toilet (P = .0013), flatulence (P = .0013), bowel cramp (P <.0001), mucus (P =.0014), blood in stool (P <.0001), and limitation in daily activity (P = .0014).
However, at the 6-year follow-up, Dr Fransson and colleagues reported no difference in deterioration between the groups for urinary bother (33% for conventional fractionation patients vs 28% ultra-hypofractionation patients).
The reported overall QOL between the groups was 42% for conventional fractionation and 37% for ultra-hypofractionation.
Ultra-hypofractionation radiotherapy demonstrates comparable QOL results to conventional fractionation in the long term. Though acute toxicity was initially higher for ultra-hypofractionation, 6 years post-treatment, patient-reported QOL suggests that this treatment is as tolerable as conventional fractionation.
These finding demonstrate ultra-hypogractionation’s efficacy for treating intermediate-to-high-risk prostate cancer.—Marta Rybczynski
