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Prostate cancer: toxicity with prostate only vs prostate and pelvic node IMRT

There are no clinically relevant differences in functional outcomes or health-related quality of life (HRQoL) in men with high-risk or locally advanced prostate cancer who undergo prostate only intensity-modulated radiotherapy (PO-IMRT) versus prostate and pelvic lymph nodes IMRT (PPLN-IMRT), according to a new study led by the London School of Hygiene and Tropical Medicine.

Little is known about the toxicity of additional pelvic lymph node irradiation in men receiving IMRT for prostate cancer.

The study recruited patients diagnosed with high-risk or locally advanced prostate cancer in NHS England between April 2014 and September 2016 treated with IMRT. Patients were mailed a questionnaire at least 18 months after the diagnosis.

Patient-reported urinary, sexual, bowel and hormonal functional domains were measured on a scale from 0 to 100, with higher scores indicating better outcomes. HRQoL was measured using the Expanded Prostate Cancer Index Composite 26-item version (EPIC-26) and EQ-5D-5L.

Of the 7017 men who received the questionnaire, 5468 (77.9%) responded, with 4196 (76.7%) having received PO-IMRT and 1272 (23.3%) PPLN-IMRT. Adjusted differences in EPIC-26 domain scores were smaller than one (P>.2) except for sexual function with men who had PPNL-IMRT reporting a lower mean score (adjusted difference, 2.3; 95% CI, 0.9-3.7; P=.002), which did not represent a clinically relevant difference. There was no significant difference in HRQoL (P=.5).

The authors concluded that additional pelvic lymph node irradiation does not lead to clinically meaningful increases in the toxicity of IMRT according to patient-reported functional outcomes and HRQoL.


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