Clinical and translational radiation oncology · 2026
Prospective evaluation of acute side effects profiles in moderately hypofractionated whole-pelvic radiotherapy for prostate cancer.
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Andexlinger Leo, Knäusl Barbara, Renner Andreas, Schmid Maximilian, Georg Dietmar, Widder Joachim, Goldner Gregor, Heilemann Gerd
Аннотация
BACKGROUND: Outcomes of whole-pelvic radiotherapy (WPRT) in the era of moderately hypofractionated radiotherapy for prostate cancer remain sparsely reported. Previous studies indicate a high discrepancy between patient-reported outcomes (PROs) and clinician-reported outcomes (CROs) assessing the same endpoint. This study analyzed the concordance between PROs and CROs for WPRT and prostate-only radiotherapy (PRT) patients.
METHODS: Patients received a prescribed dose of 20 × 3 Gy to the planning target volume (PTV) and, in cases of lymph node involvement, 46 Gy to the regional lymph nodes. 176 WPRT and 62 PRT patients reported genitourinary (GU) and gastrointestinal (GI) adverse events through an electronic patient-reported outcome measures tool. Simultaneously, clinicians graded side effects using Radiation Therapy Oncology Group (RTOG) criteria for up to two years post-radiotherapy. Composite GU and GI PRO scores, derived by averaging endpoints, were evaluated for their ability to discriminate RTOG G1+ events via receiver operating characteristic curve analysis.
RESULTS: During treatment, WPRT patients exhibited elevated GI scores compared to PRT patients via PROs (mean: 2.80 vs. 2.48, p=0.010) and CROs (mean: 1.15 vs. 0.89, p=0.014), though levels equalized by 12 months. Composite PRO scores demonstrated moderate-to-good discriminatory performance for elevated CRO levels (areas under the curves: GI 0.65-0.74; GU 0.73-0.82) from the acute phase through 24 months.
CONCLUSION: WPRT was associated with increased acute GI adverse effects but showed recovery to PRT levels within one year. Results demonstrated that PROs yield clinically relevant discriminatory value. Routine integration of PROs may facilitates earlier adverse event identification, allocation of clinical resources, and individualized clinical decision-making.
METHODS: Patients received a prescribed dose of 20 × 3 Gy to the planning target volume (PTV) and, in cases of lymph node involvement, 46 Gy to the regional lymph nodes. 176 WPRT and 62 PRT patients reported genitourinary (GU) and gastrointestinal (GI) adverse events through an electronic patient-reported outcome measures tool. Simultaneously, clinicians graded side effects using Radiation Therapy Oncology Group (RTOG) criteria for up to two years post-radiotherapy. Composite GU and GI PRO scores, derived by averaging endpoints, were evaluated for their ability to discriminate RTOG G1+ events via receiver operating characteristic curve analysis.
RESULTS: During treatment, WPRT patients exhibited elevated GI scores compared to PRT patients via PROs (mean: 2.80 vs. 2.48, p=0.010) and CROs (mean: 1.15 vs. 0.89, p=0.014), though levels equalized by 12 months. Composite PRO scores demonstrated moderate-to-good discriminatory performance for elevated CRO levels (areas under the curves: GI 0.65-0.74; GU 0.73-0.82) from the acute phase through 24 months.
CONCLUSION: WPRT was associated with increased acute GI adverse effects but showed recovery to PRT levels within one year. Results demonstrated that PROs yield clinically relevant discriminatory value. Routine integration of PROs may facilitates earlier adverse event identification, allocation of clinical resources, and individualized clinical decision-making.