# Prospective controlled study comparing patient-reported outcomes after daily online adaptive radiotherapy or conventional IGRT in patients with prostate cancer

## TL;DR

A study found that online adaptive radiotherapy may improve patient-reported quality of life outcomes compared to conventional radiotherapy in prostate cancer patients.

## Contribution

This is the first prospective study comparing patient-reported outcomes between online adaptive radiotherapy and conventional IGRT in prostate cancer treatment.

## Key findings

- Online adaptive radiotherapy showed trends of smaller declines in urinary health-related quality of life compared to conventional IGRT.
- Patients treated with online ART reported less urinary urgency and fecal incontinence post-treatment.
- Fewer patients on oART reached clinically meaningful deterioration thresholds for bowel and urinary symptoms.

## Abstract

•Urinary HRQoL decline tends to be smaller with CBCT-based oART than IGRT.•Patients treated with online ART show reduced urinary urgency post-treatment.•Online ART reduced MCID in bowel symptoms by 20 % vs. IGRT.•Online adaptation potentially enhances organ sparing without changing PTV margins.

Urinary HRQoL decline tends to be smaller with CBCT-based oART than IGRT.

Patients treated with online ART show reduced urinary urgency post-treatment.

Online ART reduced MCID in bowel symptoms by 20 % vs. IGRT.

Online adaptation potentially enhances organ sparing without changing PTV margins.

To compare patient-reported outcome measures (PROMs) in patients treated either with cone-beam CT (CBCT)-based online adaptive radiotherapy (oART) or with CBCT-guided conventional image guided radiotherapy (IGRT).

In this prospective study with convenience allocation, patients with localized prostate cancer received 62 Gy/20 fractions using either daily CBCT-based oART or CBCT-guided conventional IGRT. PROMs (EPIC, QLQ-PR25, IPSS, NCI-PRO-CTCAE) were collected at baseline and at end of therapy. Changes in scores and clinically meaningful deterioration, based on established minimal clinically important differences (MCID), were analyzed.

Seventy-four patients were included (oART: 58.1 %; IGRT: 41.9 %). Groups were demographically similar, although the oART group included more patients with high-risk tumors (40.5 % vs. 9.7 %, p = 0.03). Patients after oART tended to experience smaller, although not statistically significant, declines in health-related quality of life (HRQoL) domains compared to IGRT: EPIC urinary summary (−12.15 vs −20.57, p = 0.07), urinary function (−9.53 vs −17.47, p = 0.05), urinary incontinence (−5.47 vs −13.93, p = 0.07) and PR25 urinary symptom (20.0 vs. 27.5, p = 0.06). EPIC bowel function decline was also less pronounced (−12.64 vs. −19.78, p = 0.10). NCI-PRO-CTCAE scores favored oART for reduced urinary urgency (0.95 vs. 1.57, p = 0.02) and fecal incontinence (0.03 vs. 0.71, p = 0.02). Fewer oART patients reached MCID thresholds for urinary (8–21 %) and bowel (20–23 %) deterioration, but these differences were not statistically significant.

Our results suggest a small but consistent trend in PROM scores favoring oART over conventional IGRT. In addition, the results may inform the design of controlled randomized trials in the future.