Calidad de vida a largo plazo en una cohorte de adultos mayores chilenos, tratados de cáncer de próstata con radioterapia de intensidad modulada (IMRT) / Long-term quality of life in a cohort of Chilean older adults, treated for Prostate cancer with modulated intensity radiotherapy (IMRT)

Introducción: El cáncer de próstata (CP) presenta una alta prevalencia. La radioterapia con intensidad modulada (IMRT) esuna nueva técnica con impacto poco conocido en la calidad de vida a largo plazo (CDVALP) de estos pacientes. El objetivo fue evaluar CDVALP en este grupo. Materiales y Método: Se incluyeron pacientes tratados entre 2000-2010, con más de 1 año de seguimiento. Se utilizó cuestionario EPIC, que fue completado directamente por el paciente. Se evaluaron dominios objetivos y subjetivos de hábitos urinarios, intestinales, hormonales y sexuales. Estudio aprobado por el comité de ética. Resultados: Se analizaron 45 encuestas. La mediana de edad fue 75 años (rango 55-90), seguimiento 4,4 años (rango 1,5-8,5). Tasa respuesta promedio fue de 96,9 por ciento. La toxicidad moderada-importante objetiva para dominio urinario fue: escape urinario 8,8 por ciento, disuria 4,4 por ciento, incontinencia 4,4 por ciento, uso pañales 2,2 por ciento, hematuria 6,6por ciento. En lo subjetivo, la polaquiuria fue "un problema grande" en 6,7 por ciento. La toxicidad intestinal objetiva moderada-importante fue: frecuencia deposición 8,9 por ciento, diarrea 4,4 por ciento, pujo 6,6 por ciento, incontinencia 4,4 por ciento, hematoquezia 0 por ciento. En el dominio hormonal: bochornos significativos 11,1 por ciento. En dominio sexual: compromiso importante del deseo 57,6 por ciento, erección 66,7 por ciento, orgasmo 55,6 por ciento, en globo 62,4 por ciento, Subjetivamente la disfunción eréctil se consideró "un problema grande" en 31,1 por ciento . En globo, la disfunción sexual subjetiva se consideró importante en 24,4 por ciento y moderada en 17,8 por ciento. Conclusiones: La radioterapia con IMRT se asocia a buena CDVALP en dominios urinario, intestinal, hormonal. La alta toxicidad sexual podría estar asociada a la edad avanzada de los pacientes tratados con radioterapia.(AU)

Background: Prostate cancer has a high prevalence. Intensity modulated radiation therapy (IMRT) is a new technique with little known impact on quality of life (QOL) in the long term of these patients. The objective was to evaluate QOL in this group. Materials and Methods: We included patients from 2000 to 2010, with more than 1 year follow-up. EPIC questionnaire was completed by the patient directly. We evaluated objective and subjective domains urinary and bowel habits, hormonal and sexual symptoms. Study approved by the ethics committee. Results: 45 surveys were analyzed. The median age was 75 years (range 55-90); follow up was 4.4 years (range 1.5-8.5). Average response rate was 96.9 percent. Toxicity moderately important objective for urinary domain was: urinary escape 8,8 percent, dysuria 4,4 percent, incontinence 4.4 percent, use diapers 2,2, hematuria 6,6 percent. In the subjective, polakiuria was "a big problem" in 6,7 percent. Objective Intestinal toxicity moderately important was: deposition rate 8,9. percent, diarrhea 4.4 percent, incontinence 4.4 percent, hematochezia 0 percent. In the hormonal domain clinical significant hot flashes in was 11.1 percent. In sexual domain: significant desire dysfunction in 57.6 percent, erection 66.7, orgasm 55.6 percent, Sexual overall 62.4 percent, subjectively erectile dysfunction was considered "a big problem" in 31.1 percent. Overall, subjective sexual dysfunction was considered important by 24.4 percent and moderate in 17.8 percent. Conclusions: IMRT radiation therapy is associated with good CDVALP in domains urinary, bowel, hormonal. The sexual high toxicity may be associated with older age of patients treated with radiotherapy.(AU)

Intensity-modulated radiotherapy versus radical prostatectomy in patients with localized prostate cancer: long-term follow-up.

BACKGROUND: The objective of this work was to assess the overall survival, cause-specific survival and biochemical failure-free survival of a contemporary cohort of patients with localized prostate cancer (PCa) treated with intensity-modulated radiation therapy (IMRT) or radical prostatectomy (RP). METHODS: We did a retrospective cohort study of our institution's registry of patients undergoing either IMRT or RP between January 1999 and March 2010, and assessed Prostate Specific Antigen (PSA), age at diagnosis, Gleason score, and digital rectal examination. Two groups were separated according to RP or IMRT treatment and these groups were in turn divided into risk groups according to the D'Amico classification. Overall survival (OS), cause-specific survival (CSS), mortality from other causes (MOC), and biochemical disease-free survival (BDFS) were assessed. RESULTS: Twelve-hundred patients were included: 993 in the RP group and 207 in the IMRT group.The IMRT group had older age, PSA at diagnosis and a significantly higher percentage of cancer on the needle biopsy (p <0.001). Of the 207 patients who underwent IMRT, 54% presented comorbidities. Median follow-up was 91.7 months for the RP group and 76 months for the IMRT group. The OS at 5 and 7 was 96.2, and 93.7 for the RP group respectively and 88.4, and 83.1 for the IMRT group respectively (p <0.001). There were no significant differences in the CSS in relation to treatment received among the low- and high-risk groups, while in the intermediate-risk group, patients who underwent to RP had a higher CSS than patients who underwent IMRT (99.6% vs 94.1%, p=0.003). The IMRT group had a significantly better BDFS than the RP group (86.4% vs. 74.3%, respectively, p=0.016). CONCLUSIONS: Patients treated with RP were significantly younger and had a better prognosis than patients treated using IMRT, and according to our results, RP had better outcomes in terms of OS while IMRT had greater MOC. Treatment modality did not affect the CSS.