Reporting combined outcomes with Trifecta and survival, continence, and potency (SCP) classification in 337 patients with prostate cancer treated with image-guided hypofractionated radiotherapy

Authors

  • Barbara A. Jereczek-Fossa,

    1. Department of Radiation Oncology, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
    2. University of Milan, Milan, Italy
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  • Dario Zerini,

    1. Department of Radiation Oncology, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
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  • Cristiana Fodor,

    1. Department of Radiation Oncology, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
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  • Luigi Santoro,

    1. Department of Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
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  • Andrea Maucieri,

    1. Department of Radiation Oncology, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
    2. University of Milan, Milan, Italy
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  • Marianna A. Gerardi,

    1. Department of Radiation Oncology, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
    2. University of Milan, Milan, Italy
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  • Barbara Vischioni,

    Corresponding author
    1. Centro Nazionale di Adroterapia Oncologica (CNAO), Pavia, Italy
    • Correspondence: Barbara Vischioni, Division of Radiation Oncology and Radiobiology, Centro Nazionale Adroterapia Oncologica (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.

      e-mail: vischioni@cnao.it

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  • Raffaella Cambria,

    1. Department of Medical Physics, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
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  • Cristina Garibaldi,

    1. Department of Medical Physics, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
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  • Federica Cattani,

    1. Department of Medical Physics, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
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  • Andrea Vavassori,

    1. Department of Radiation Oncology, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
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  • Deliu V. Matei,

    1. Department of Urology, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
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  • Gennaro Musi,

    1. Department of Urology, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
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  • Ottavio De Cobelli,

    1. Department of Urology, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
    2. University of Milan, Milan, Italy
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  • Roberto Orecchia

    1. Department of Radiation Oncology, the Epidemiology and Biostatistics of the European Institute of Oncology, Milan, Italy
    2. University of Milan, Milan, Italy
    3. Centro Nazionale di Adroterapia Oncologica (CNAO), Pavia, Italy
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Abstract

Objective

  • To report the image-guided hypofractionated radiotherapy (hypo-IGRT) outcome for patients with localised prostate cancer according to the new outcome models Trifecta (cancer control, urinary continence, and sexual potency) and SCP (failure-free survival, continence and potency).

Patients and Methods

  • Between August 2006 and January 2011, 337 patients with cT1–T2N0M0 prostate cancer (median age 73 years) were eligible for a prospective longitudinal study on hypo-IGRT (70.2 Gy/26 fractions) in our Department.
  • Patients completed four questionnaires before treatment, and during follow-up: the International Index of Erectile Function-5 (IIEF-5), the International Prostate Symptom Score (IPSS), and the European Organization for Research and Treatment of Cancer prostate-cancer-specific Quality of Life Questionnaires (QLQ) QLQ-PR25 and QLQ-C30.
  • Baseline and follow-up patient data were analysed according to the Trifecta and SCP outcome models. Cancer control, continence and potency were defined respectively as no evidence of disease, score 1 or 2 for item 36 of the QLQ-PR25 questionnaire, and total score of >16 on the IIEF-5 questionnaire.
  • Patients receiving androgen-deprivation therapy (ADT) at any time were excluded.

Results

  • Trifecta criteria at baseline were met in 72 patients (42% of all ADT-free patients with completed questionnaires).
  • Both at 12 and 24 months after hypo-IGRT, 57% of the Trifecta patients at baseline were still meeting the Trifecta criteria (both oncological and functional success according to the SCP model).
  • The main reason for failing the Trifecta criteria during follow-up was erectile dysfunction: in 18 patients after 6 months follow-up, in 12 patients after 12 months follow-up, and in eight patients after 24 months.
  • Actuarial 2-year Trifecta failure-free survival rate was 44% (95% confidence interval 27–60%).
  • In multivariate analysis no predictors of Trifecta failure were identified. Missing questionnaires was the main limitation of the study.

Conclusion

  • The Trifecta and SCP classifications can be used as tools to report RT outcome.

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