Patient-reported outcome measures for technology assessment: A comparison between three-dimensional conformal and intensity-modulated radiotherapy in prostate cancer

doi:10.5306/wjco.v17.i3.115774

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Mar 24, 2026 (publication date) through Mar 26, 2026

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World Journal of Clinical Oncology

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Oncol. Mar 24, 2026; 17(3): 115774
Published online Mar 24, 2026. doi: 10.5306/wjco.v17.i3.115774

Table 1 Unweighted and weighted description of patient characteristics before treatment, n (%)/mean (SD or SE)

	Unweighted			Weighted
	3D-CRT cohort	IMRT cohort	P value	3D-CRT cohort	IMRT cohort	P value
Age (years)	69.1 (4.8)	69.6 (4.6)	0.470	69.1 (0.5)	69.1 (1.2)	0.975
Smoking status (%)
Never smoked	29 (33.7)	25 (24.3)	< 0.001	29 (33.7)	13 (25.4)	0.614
Current smoker	18 (20.9)	63 (61.2)		18 (20.9)	11 (20.7)
Ex-smoker	39 (45.3)	15 (14.6)		39 (45.3)	28 (53.9)
Prostate volume (cc)	43.2 (22.8)	39.5 (14.1)	0.226	43.2 (2.5)	41.5 (2.2)	0.370
Gleason total	5.3 (1.1)	6.1 (0.3)	< 0.001	5.3 (0.1)	6.1 (0.0)	< 0.001
6 or less (%)	88 (95.7)	93 (87.7)	0.084	88 (95.7)	50 (94.8)	0.794
7 or more (%)	4 (4.3)	13 (12.3)		4 (4.3)	3 (5.2)
Prostate-specific antigen (ng/mL)	6.7 (1.7)	6.2 (1.8)	0.069	6.7 (0.2)	6.3 (0.3)	0.337
T stage (%)
T1c	72 (78.3)	88 (83)	0.505	72 (78.3)	39 (74.6)	0.735
T2a	20 (21.7)	18 (17)		20 (21.7)	13 (25.4)
Risk group (%)
Low	88 (95.7)	92 (86.8)	0.056	88 (95.7)	49 (93.5)	0.531
Intermediate	4 (4.3)	14 (13.2)		4 (4.3)	3 (6.5)
Comorbidity (%)	76 (88.4)	80 (75.5)	0.037	76 (88.4)	43 (81.2)	0.388
Urological history (%)	20 (21.7)	37 (34.9)	0.060	20 (21.7)	13 (24.2)	0.803
Bowel history (%)	22 (23.9)	16 (15.1)	0.164	22 (23.9)	9 (17.2)	0.526

SD in the unweighted columns and SE in the weighted columns. IMRT: Intensity-modulated radiotherapy; 3D-CRT: Three-dimensional conformal radiotherapy.

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Table 2 Weighted expanded prostate cancer index composite and short form-36 health survey results over time from Generalized Estimating Equation repeated-measures models, adjusted by Gleason score, means (95%CI)

	EPIC urinary incontinence	EPIC urinary irritative/obstructive	EPIC bowel summary	EPIC sexual summary	SF-36 physical component summary	SF-36 mental component summary
Cohort treated with three-dimensional conformal radiotherapy
Pre-treatment	95.1 (92.9-97.4)	95.9 (93.9-98.2)	98.9 (97.5-100.3)	51.9 (47.2-56.3)	51.4 (50.3-52.6)	55.2 (54.2-56.1)
3 months	91.8 (88.6-95.0)^a	89.0 (86.0-92.2)^a	95.3 (92.8-97.8)^a	44.4 (39.4-49.2)^a	51.7 (50.7-52.8)	54.7 (53.6-56.0)
6 months	93.8 (91.0-97.0)	93.7 (91.7-96.1)	96.0 (93.9-98.0)^a	49.6 (44.4-54.7)	51.0 (50.1-51.9)	55.8 (54.9-57.0)
12 months	93.3 (90.9-95.9)	95.8 (94.3-97.4)	94.8 (92.5-97.4)^a	47.4 (42.4-52.9)	50.3 (49.2-51.3)^a	56.2 (55.0-57.4)^a
24 months	92.5 (89.9-95.5)	94.0 (92.2-95.9)	93.7 (91.1-96.4)^a	41.8 (36.1-47.0)^a	48.9 (47.7-50.1)^a	56.1 (55.0-57.3)
36 months	89.3 (86.0-92.5)^a	89.2 (86.2-92.4)^a	92.5 (89.4-96.0)^a	42.1 (36.6-47.6)^a	46.2 (44.8-47.6)^a	54.3 (52.9-55.9)
48 months	90.8 (87.4-94.3)^a	87.3 (83.8-91.2)^a	93.4 (90.8-96.4)^a	34.2 (28.9-39.7)^a	46.0 (44.6-47.5)^a	52.2 (50.4-54.0)^a
60 months	88.6 (84.5-92.6)^a	87.9 (84.4-91.5)^a	94.4 (92.3-96.9)^a	30.7 (26.1-35.2)^a	44.9 (43.3-46.6)^a	53.3 (51.6-55.2)^a
Cohort treated with intensity-modulated radiotherapy
Pre-treatment	92.1 (88.3-95.8)	89.9 (86.3-93.6)	97.9 (96.9-99.0)	62.8 (56.6-70.2)	49.1 (47.0-51.4)	50.8 (48.4-53.3)
3 months	87.3 (82.4-93.2)	82.6 (76.7-88.9)	95.2 (93.1-97.1)^a	49.6 (42.4-57.1)^a	47.3 (45.4-49.3)	53.9 (51.4-56.6)^a
6 months	85.0 (79.7-90.5)^a	88.7 (83.6-94.5)	95.7 (93.0-98.5)	53.2 (46.4-60.1)^a	46.3 (44.5-48.4)^a	54.9 (53.2-56.7)^a^,^b
12 months	89.1 (84.2-94.5)	85.9 (81.4-91.0)	95.0 (93.0-97.1)^a	49.7 (43.5-56.4)^a	46.9 (45.1-48.6)^a	54.4 (52.7-56.3)^a
24 months	91.2 (86.4-96.3)	90.0 (86.2-94.1)	97.6 (96.2-99.1)^b	44.4 (38.1-50.5)^a	47.0 (45.3-49.0)^a	55.2 (53.7-56.9)^a^,^b
36 months	89.5 (84.6-94.3)	91.5 (88.5-94.6)^b	95.4 (93.1-97.4)^a	39.4 (33.1-45.4)^b	45.8 (44.1-47.7)^a	54.4 (52.5-56.5)^a^,^b
48 months	88.0 (82.2-94.5)	93.5 (89.7-96.5)^b	99.0 (96.7-101.7)^b	33.9 (27.7-40.1)^b	43.1 (41.1-45.4)^a	56.2 (54.2-58.3)^a^,^b
60 months	89.3 (84.0-94.8)	90.0 (86.5-93.4)^b	94.1 (91.1-97.9)	33.3 (25.0-40.5)^a	41.9 (39.9-44.2)^a	51.6 (48.9-54.8)

^aP < 0.05 in the comparison of the mean score between pre-treatment and post-treatment.

^bP < 0.05 in the comparison of the mean score change since pre-treatment between patients treated with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy (reference group).

EPIC: Expanded prostate cancer index composite; SF-36: Short form-36 health survey.

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Table 3 Linear regression of image-guided radiation therapy characteristics and patient-reported outcomes in intensity-modulated radiotherapy cohort (n = 106), n (%)/mean (SD or SE)

	EPIC urinary incontinence	P value	EPIC urinary irritative/obstructive	P value	EPIC bowel summary	P value	EPIC sexual summary	P value	SF-36 physical component summary	P value	SF-36 mental component summary	P value
Intercept	-22.4 (28.6)	0.436	34.0 (29.4)	0.250	92.2 (36.8)	0.014	45.8 (45.9)	0.320	17.2 (11.5)	0.139	36.8 (12.7)	0.005
Pre-treatment score	0.6 (0.1)	< 0.001	0.4 (0.1)	< 0.001	0.0 (0.2)	0.952	0.5 (0.1)	< 0.001	0.4 (0.1)	< 0.001	0.3 (0.1)	0.001
CBCT+ planning target volume margins combined
No CBCT; > 5 mm	Reference		Reference		Reference		Reference		Reference		Reference
CBCT; 5 mm or less	14.4 (7.2)	0.048	2.6 (7.3)	0.720	-9.9 (6.3)	0.122	0.1 (11.0)	0.989	-3.3 (2.7)	0.217	2.2 (3.3)	0.503
CBCT; > 5 mm	-2.2 (6.0)	0.709	-4.3 (6.2)	0.489	-8.1 (5.3)	0.133	2.2 (9.3)	0.817	-1.7 (2.3)	0.464	-1.1 (2.7)	0.680
Equivalent dose in 2 Gy fractions
≤ 78	Reference		Reference		Reference		Reference		Reference		Reference
> 78	-8.4 (5.2)	0.113	-15.2 (5.4)	0.006	-3.2 (4.7)	0.494	-5.8 (8.0)	0.471	-2.4 (2.1)	0.256	0.0 (2.4)	0.993
Dose per fraction
< 3 Gy/fraction	Reference		Reference		Reference		Reference		Reference		Reference
≥ 3 Gy/fraction	-13.6 (6.2)	0.030	-11.1 (6.1)	0.075	3.5 (5.2)	0.504	-2.4 (9.0)	0.794	4.0 (2.2)	0.070	-3.1 (2.7)	0.253
Risk
Low	Reference		Reference		Reference		Reference		Reference		Reference
Intermediate	-1.2 (5.5)	0.823	3.4 (5.7)	0.550	3.5 (4.9)	0.479	4.4 (8.5)	0.604	3.0 (2.1)	0.148	0.4 (2.5)	0.865
Age	0.8 (0.4)	0.031	0.4 (0.4)	0.334	0.1 (0.3)	0.818	-0.4 (0.6)	0.542	0.1 (0.1)	0.464	0.1 (0.2)	0.752

Equivalent dose in 2 Gy fractions, calculated using the linear-quadratic model to standardize comparisons across different fractionation schedules (α/β prostate: 1.5). CBCT: Cone-beam computed tomography; EPIC: Expanded prostate cancer index composite; SF-36: Short form-36 health survey.

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Citation: Mera A, Sancho G, Garin O, Pont À, Pardo Y, Macias V, Hervas A, Cabrera P, Ferrer F, Roselló À, Samper Ots P, García ME, Jové-Teixidó J, Ferrer M, The Multicentric Spanish Group of Clinically Localized Prostate Cancer. Patient-reported outcome measures for technology assessment: A comparison between three-dimensional conformal and intensity-modulated radiotherapy in prostate cancer. World J Clin Oncol 2026; 17(3): 115774
URL: https://www.wjgnet.com/2218-4333/full/v17/i3/115774.htm
DOI: https://dx.doi.org/10.5306/wjco.v17.i3.115774