Patient-reported outcome measures for technology assessment: A comparison between three-dimensional conformal and intensity-modulated radiotherapy in prostate cancer
Mera, Arantxa (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Sancho-Pardo, Gemma (Universitat Autònoma de Barcelona. Departament de Medicina)
Garin, Olatz (Institut Hospital del Mar d'Investigacions Mèdiques)
Pont, Angels (Institut Hospital del Mar d'Investigacions Mèdiques)
Pardo Cladellas, Yolanda (Institut Hospital del Mar d'Investigacions Mèdiques)
Macías Hernández, Víctor (Hospital Universitari i Politècnic La Fe (València))
Hervás Morón, Asunción (Hospital Universitario Ramón y Cajal (Madrid))
Cabrera, Patricia (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Ferrer i Julià, Ferran (Institut Català d'Oncologia)
Roselló Serrano, Àlvar (Institut Català d'Oncologia)
Samper, Pilar (Hospital Universitario Rey Juan Carlos (Madrid))
García, María Elena (Hospital Arnau de Vilanova (Lleida, Catalunya))
Jové, Josep (Institut Català d'Oncologia)
Ferrer Forés, Maria Montserrat (Institut Hospital del Mar d'Investigacions Mèdiques)

Data:	2026
Resum:	BACKGROUND: Technological innovation in radiotherapy demands evaluation not only through dosimetric or clinician-reported outcomes, but also through patient-centred measures. Patient-reported outcome measures (PROMs) provide a unique insight into how advances such as intensity-modulated radiotherapy (IMRT) affect daily functioning and quality of life, compared to conventional techniques. Despite the clear dosimetric benefits over three-dimensional conformal radiotherapy (3D-CRT), evidence on whether IMRT translates into superior patient-reported outcomes remains inconsistent. PROM-based assessment offers a robust framework to evaluate the real clinical value of radiotherapy technologies and their impact on long-term quality of life in localized prostate cancer. AIM: To compare 3D-CRT and IMRT using PROMs and to examine the influence of image-guided techniques on outcomes. METHODS: The observational study compared two independent cohorts of localized prostate cancer patients followed for five years: (1) 92 were treated with 3D-CRT (2003-2005); and (2) 106 with IMRT (2013-2019). PROMs were assessed using the expanded prostate cancer index composite and short form-36 health survey before treatment and annually, via centralized telephone interviews. Propensity score-weighted Generalized Estimating Equation models were constructed with adjustment for baseline differences. Within the IMRT cohort, a multivariate regression explored associations between image guidance, fractionation, and dose escalation and urinary outcomes 12 months post-treatment. RESULTS: Both radiotherapy techniques were associated with sustained high long-term health-related quality of life, according to patient-reported data. Significant differences between modalities emerged from the second year or third year post-treatment in the expanded prostate cancer index composite urinary, bowel, and sexual domains. Patients treated with IMRT reported better trajectories in mental health (short form-36 health survey) compared with those treated with 3D-CRT. Within the IMRT cohort, the use of Cone-Beam Computed Tomography-based image guidance and reduced planning margins (≤ 5 mm) was associated with improved preservation of urinary continence (P = 0. 048). Conversely, higher equivalent dose in 2-Gy fractions doses (> 78 Gy) and hypofractionation (≥ 3 Gy/fraction) were associated to greater short-term deterioration in urinary incontinence (P = 0. 030) and irritative/obstructive symptoms (P = 0. 006). CONCLUSION: PROMs reveal the real-world impact of radiotherapy advances from the patient’s perspective. IMRT improved urinary and bowel outcomes, supporting PROMs as valid tools for technology assessment and patient-centred treatment optimization.
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Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	World Journal of Clinical Oncology, Vol. 17, Num. 3 (March 2026) , art. 115774, ISSN 2218-4333

DOI: 10.5306/wjco.v17.i3.115774

15 p, 10.4 MB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
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