# Optimising acute toxicity monitoring in prostate MR-guided radiotherapy workflow: Results from a prospective study using multiple electronic PRO assessments

## TL;DR

Using frequent electronic patient-reported outcomes (ePROs) during prostate cancer radiotherapy helps track acute toxicity and quality of life in real time.

## Contribution

This study demonstrates the feasibility and value of integrating frequent ePRO assessments into prostate MR-guided radiotherapy workflows.

## Key findings

- ePROs revealed symptom worsening outside standard follow-up schedules, especially for urinary and bowel symptoms.
- Moderate symptom worsening did not significantly impact health-related quality of life (HRQoL) in most patients.
- Patients receiving different radiation doses showed distinct patterns in symptom duration and HRQoL improvements.

## Abstract

•Multiple ePRO assessments reveal timely changes in the prevalence of acute toxicity.•ePRO trajectories highlight symptom worsening outside standard follow-up schedules.•Symptom peaks post-treatment underscore the need for frequent ePRO monitoring.•Moderate symptom worsening did not translate into decreased HRQoL.•High response rates of multiple ePROs among patients with localised and metastatic PCa.

Multiple ePRO assessments reveal timely changes in the prevalence of acute toxicity.

ePRO trajectories highlight symptom worsening outside standard follow-up schedules.

Symptom peaks post-treatment underscore the need for frequent ePRO monitoring.

Moderate symptom worsening did not translate into decreased HRQoL.

High response rates of multiple ePROs among patients with localised and metastatic PCa.

Frequent electronic patient-reported outcomes (ePROs) may become an important tool for monitoring outcomes in ultrahypofractionated MRgRT for prostate cancer, enabling real-time remote tracking of toxicity. By integrating weekly ePROs and health-related quality of life (HRQoL) assessments into the early prostate MRgRT workflow, this study aimed to explore real-time acute symptom trajectories and the impact on HRQoL.

Two cohorts were followed: Patients receiving MRgRT for localised PCa (60Gy/20fx) or low-volume metastatic (M1) PCa (36Gy/6fx) and eligible to complete weekly ePROs and HRQoL measures (EQ-5D-5L, EORTC QLQ-C30) during and up to 24 weeks of follow-up. Linear mixed models were used to evaluate symptom changes over time.

Of 76 included PCa patients, 42 had localised PCa and 34 low-volume M1 PCa. The linear model revealed significant changes in urinary symptoms from treatment week one, persisting 2 weeks post-MRgRT in the 36 Gy cohort, and 3–4 weeks in the 60 Gy cohort. Bowel symptoms increased early post-treatment in both cohorts, with diarrhoea being most frequent. Clinically relevant changes in HRQoL were observed during follow-up: patients in the 60 Gy cohort showed HRQoL improvements after 12 and 24 weeks. In the 36 Gy cohort, patients reported improved self-rated Global health status/QoL and emotional functioning.

Frequent ePROs during and after MRgRT provide critical insights into the timing, fluctuation and severity of acute toxicity, potentially missed with standard follow-up schedules. Integrating real-time ePROs into the MRgRT workflow is a feasible patient-centered method to systematically optimize the outcome assessments of MRgRT.