149 - Quality of Life after Adjuvant or Salvage Radiotherapy Following Radical Prostatectomy: A Secondary Analysis of the TROG 08.03 RAVES Randomized Controlled Trial
Presenter(s)
J. Smith1,2, G. Duchesne3, A. Kneebone4,5, M. Pearse6, C. Fraser-Browne6, L. Leigh7, M. Lehman1,2, S. Turner5,8, C. I. Tang9,10, M. Sidhom11,12, T. S. Lim13,14, S. G. Williams3, K. L. Wiltshire3, D. J. Joseph9,15, J. H. L. Matthews16, J. L. Millar17,18, N. Spry9, M. Frydenberg19, H. Woo5, and J. M. Martin20,21; 1Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia, 2Faculty of Medicine, University of Queensland, Brisbane, Australia, 3Peter MacCallum Cancer Centre, Melbourne, Australia, 4Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia, 5Sydney Medical School, University of Sydney, Sydney, Australia, 6Auckland Hospital, Auckland, New Zealand, 7Hunter Medical Research Institute, Newcastle, Australia, 8Westmead Hospital, Crown Princess Mary Cancer Care Centre, Sydney, Australia, 9Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia, 10Edith Cowan University, Perth, Australia, 11Liverpool Cancer Therapy Centre, Sydney, Australia, 12South Western Sydney Clinical School, University of New South Wales, Sydney, Australia, 13University of Western Australia, Department of Surgery, Perth, Australia, 14GenesisCare, Fiona Stanley Hospital, Perth, Australia, 15University of Western Australia, Perth, Australia, 16Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand, 17Alfred Health Radiation Oncology, Melbourne, VIC, Australia, 18School of Translational Medicine, Monash University, Melbourne, Australia, 19Monash University Faculty of Medicine, Melbourne, Australia, 20University of Newcastle, Newcastle, Australia, 21Radiation Oncology Calvary Mater Newcastle Hospital, Newcastle, Australia
Purpose/Objective(s):
This study aims to assess: 1. Differences in patient reported quality of life (QOL) for patients randomized to adjuvant or salvage radiotherapy (aRT or sRT) after radical prostatectomy (RP), and 2. The impact of time from RP to RT on QOL. We hypothesize that earlier delivery of RT will have a larger detriment to QOL.Materials/Methods:
This is a protocol planned secondary analysis of the Trans-Tasman Radiation Oncology Group phase 3 randomized trial comparing aRT versus sRT following RP (TROG 08.03 RAVES, NCT00860652). Patients with high-risk pathological features after radical prostatectomy were allocated to receive aRT within 6 months of surgery or sRT if the PSA increased to =0.20. QOL was measured using the EORTC global (QLQ-30) and EORTC prostate cancer module (QLQ-PR25) at baseline and annually thereafter. Statistical analysis was performed using Stata V17, with the minimal clinically important change (MCIC) defined as a decline in QOL of >0.5 standard deviations from the baseline score of each domain.Results:
Out of a total of 333 patients, those in the aRT arm (n = 166) had a higher proportion of patients reporting a MCIC in urinary symptoms compared to the sRT arm (n = 167) at 1 (21% vs 12%, p = 0.047) and 2 years (23% vs 14%, p = 0.041) post-randomization. Similarly, patients in the aRT arm had a higher proportion of patients with a MCIC in bowel symptoms at 1 (32% vs 16%, p = 0.002) and 2 years (27% vs 18%, p = 0.047). At 5 years post randomization there was an increased proportion of patients in the aRT group with a MCIC in bowel symptoms (37% vs 20%, p = 0.009) but no differences in urinary symptoms, sexual activity or sexual functioning. Comparing patients who received aRT (n=166) versus those in the sRT who didn’t receive RT (n=87), there was an increased proportion of patients with a MCIC in bowel symptoms at all time points. There was a trend towards worse urinary symptoms in the aRT group compared to those who received no RT, although this was only statistically significant at 4 years (MCIC 25% vs 10%, p = 0.017). The median time to sRT was 32 months. Patients who received sRT within 32 months of RP (n=40) had no differences in QOL at 5 years compared to those who received sRT greater than 32 months from RP (n=40).Conclusion:
Patients receiving aRT reported an acute decline in urinary and bowel symptoms, with only a long-term worsening of bowel symptoms compared to those randomized to the sRT group. There was no long-term decline in patient reported urinary or sexual QOL in the aRT group. The timing of sRT post RP did not consistently influence long term QOL across all domains. This data suggests that RT post RP is well tolerated by patients, whilst the timing of sRT appears to have limited impact on QOL. Long-term bowel issues could potentially be mitigated through improved patient selection and radiation treatment techniques.