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

Authors

Kimberly R Gergelis
Miao Bai
Jiasen Ma
David M Routman
Bradley J Stish
Brian J Davis
Thomas M Pisansky
Thomas J Whitaker
Richard Choo

Publication Date

4-2-2025

Journal

Current Oncology

Abstract

Purpose: This study aimed to compare long-term patient-reported outcomes in bowel and urinary domains between intensity-modulated radiotherapy (IMRT) and intensity-modulated proton therapy (IMPT) for localized prostate cancer.

Methods and materials: Patients with clinical T1-T2 prostate cancer receiving IMRT or IMPT at a tertiary cancer center from 2015-2018 were analyzed to determine the changes in the prospectively collected bowel function (BF), urinary irritative/obstructive symptoms (UO), and urinary incontinence (UI) domains of EPIC-26. The mean changes in EPIC-26 scores were evaluated from pretreatment to 24 months post-radiotherapy for each modality. A score change >50% of the baseline standard deviation was considered a clinically meaningful change.

Results: A total of 82 patients treated with IMRT (52.2%) and 56 patients treated with IMPT (53.3%) completed the questionnaire at baseline and 24 months post-RT. There were no baseline differences in domain scores between treatment modalities. At 24 months post-radiotherapy, there was a significant and clinically meaningful decline in the BF mean score in the IMRT cohort (-4.52 (range -50, 29.17), p = 0.003), whereas the decline in BF score did not reach clinical relevance or significance (-1.88 (range -37.5, 50), p = 0.046) when accounting for the Bonferroni adjustment in the IMPT cohort. A higher proportion of patients treated with IMRT had a clinically relevant reduction in BF when compared with IMPT (47.37% vs. 25.93%, p = 0.017). The mean changes in the UI and UO scores of the IMRT and IMPT cohorts were neither statically significant nor clinically relevant.

Conclusions: IMPT leads to a smaller decrease in BF than IMRT at 24 months post-RT, while there was no differential effect on UO and UI.

Keywords

Humans, Male, Prostatic Neoplasms, Radiotherapy, Intensity-Modulated, Proton Therapy, Quality of Life, Aged, Middle Aged, Patient Reported Outcome Measures, Aged, 80 and over, EPIC-26, intensity-modulated proton therapy, intensity-modulated radiotherapy, prostate cancer, quality of life

DOI

10.3390/curroncol32040212

PMID

40277768

PMCID

PMC12025910

PubMedCentral® Posted Date

4-2-2025

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes