open access

Vol 25, No 2 (2020)
Original research articles
Published online: 2020-03-01
Submitted: 2019-12-02
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Choosing between conventional and hypofractionated prostate cancer radiation therapy: Results from a study of shared decision-making

Thomas P. Shakespeare, Justin Westhuyzen, Tracy Lim Yew Fai, Noel J. Aherne
DOI: 10.1016/j.rpor.2019.12.028
·
Rep Pract Oncol Radiother 2020;25(2):193-199.

open access

Vol 25, No 2 (2020)
Original research articles
Published online: 2020-03-01
Submitted: 2019-12-02

Abstract

Aim

To evaluate patient choice of prostate cancer radiotherapy fractionation, using a decision aid.

Background

Recent ASTRO guidelines recommend patients with localised prostate cancer be offered moderately hypofractionated radiation therapy after discussing increased acute toxicity and uncertainty of long-term results compared to conventional fractionation.

Materials and methods

A decision aid was designed to outline the benefits and potential downsides of conventionally and moderately hypofractionated radiation therapy. The aid incorporated the ASTRO guideline to outline risks and benefits.

Results

In all, 124 patients with localised prostate cancer were seen from June-December 2018. Median age was 72 (range 50–90), 49.6 % were intermediate risk (50.4 % high risk). All except three patients made a choice using the aid; the three undecided patients were hypofractionated. In all, 33.9 % of patients chose hypofractionation: falling to 25.3 % for patients under 75 years, 24.3 % for patients living within 30 miles of the cancer centre, and 14.3 % for patients with baseline gastrointestinal symptoms. On multivariate analysis, younger age, proximity to the centre, and having baseline gastrointestinal symptoms significantly predicted for choosing conventional fractionation. Insurance status, attending clinician, baseline genitourinary symptoms, work/carer status, ECOG, cancer risk group and driving status did not impact choice. Reasons for choosing conventional fractionation were certainty of long-term results (84 %) and lower acute bowel toxicity (51 %).

Conclusions

Most patients declined the convenience of moderate hypofractionation due to potentially increased acute toxicity, and the uncertainty of long-term outcomes. We advocate that no patient should be offered hypofractionation without a thorough discussion of uncertainty and acute toxicity.

Abstract

Aim

To evaluate patient choice of prostate cancer radiotherapy fractionation, using a decision aid.

Background

Recent ASTRO guidelines recommend patients with localised prostate cancer be offered moderately hypofractionated radiation therapy after discussing increased acute toxicity and uncertainty of long-term results compared to conventional fractionation.

Materials and methods

A decision aid was designed to outline the benefits and potential downsides of conventionally and moderately hypofractionated radiation therapy. The aid incorporated the ASTRO guideline to outline risks and benefits.

Results

In all, 124 patients with localised prostate cancer were seen from June-December 2018. Median age was 72 (range 50–90), 49.6 % were intermediate risk (50.4 % high risk). All except three patients made a choice using the aid; the three undecided patients were hypofractionated. In all, 33.9 % of patients chose hypofractionation: falling to 25.3 % for patients under 75 years, 24.3 % for patients living within 30 miles of the cancer centre, and 14.3 % for patients with baseline gastrointestinal symptoms. On multivariate analysis, younger age, proximity to the centre, and having baseline gastrointestinal symptoms significantly predicted for choosing conventional fractionation. Insurance status, attending clinician, baseline genitourinary symptoms, work/carer status, ECOG, cancer risk group and driving status did not impact choice. Reasons for choosing conventional fractionation were certainty of long-term results (84 %) and lower acute bowel toxicity (51 %).

Conclusions

Most patients declined the convenience of moderate hypofractionation due to potentially increased acute toxicity, and the uncertainty of long-term outcomes. We advocate that no patient should be offered hypofractionation without a thorough discussion of uncertainty and acute toxicity.

Get Citation

Keywords

Radiation therapy; Radiotherapy; Prostate cancer; Fractionation; Hypofractionation; Decision-making; Decision aid; IMRT

About this article
Title

Choosing between conventional and hypofractionated prostate cancer radiation therapy: Results from a study of shared decision-making

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 25, No 2 (2020)

Pages

193-199

Published online

2020-03-01

DOI

10.1016/j.rpor.2019.12.028

Bibliographic record

Rep Pract Oncol Radiother 2020;25(2):193-199.

Keywords

Radiation therapy
Radiotherapy
Prostate cancer
Fractionation
Hypofractionation
Decision-making
Decision aid
IMRT

Authors

Thomas P. Shakespeare
Justin Westhuyzen
Tracy Lim Yew Fai
Noel J. Aherne

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