Does hypofractionated radiotherapy have better or worse erectile function outcomes compared to conventional therapy?

The authors aimed to determine whether moderate hypofractionated radiotherapy would worsen sexual function after treatment.

There are many options for treatment of low-risk prostate cancer (cancer with a very small likelihood of spreading), therefore side-effects and patient preferences may drive the decision of whether surgery or radiation therapy is undertaken.

Radiation-induced erectile dysfunction can be an unwanted side-effect of radiation therapy in prostate cancer patients. New methods such as hypofractionated radiotherapy are being analysed to determine their effect on cancer control and sexual functioning. It is suggested that a more mild approach may reduce the level of erectile dysfunction experienced following treatment. Hypofractionated radiation therapy is therapy in which the total dose of radiation is divided into large doses and administered over a shorter period of time (days or weeks) compared to standard radiation therapy. 

The authors aimed to identify whether hypofractionated radiotherapy decreased erectile dysfunction after treatment in comparison to conventional fractionation (where the total dose of radiation is spread out over time to allow healthy cells to recover between treatments).

41 patients who had undergone hypofractionated radiotherapy were included in the final analysis. Patients were evaluated every 4 months for year 1, every 6 months for the following 4 years and annually thereafter.

The average SHIM before treatment was 20 (Sexual Health Inventory for Men – a questionnaire to determine how many patients experienced erectile dysfunction during sexual intercourse following treatment with higher results indicating better sexual function). 25 patients (61%) had some from of erectile dysfunction before receiving treatment.

Following radiotherapy treatment the average SHIM was 17. 33 patients (81%) had experienced some form of erectile dysfunction.

20% of patients were taking an erectile dysfunction drug PDE-5 before radiotherapy, which increased to 44% after patients received treatment. 10% received additional interventions after radiotherapy.

Erectile dysfunction was significantly decreased in 50% of patients who had an average treatment dosage > 20 Gy compared to 9%  of patients that received a dosage of < 20 Gy.Having a dose > 20 Gy was associated with 10.5 times the risk of developing sexual dysfunction. 

The authors concluded that hypofractionated radiotherapy results in the same sexual outcomes when compared to conventional fractionation.

The limitations of this study include the small group of men tested, meaning that the results potentially cannot be applied widely to all patients who may receive hypofractionated radiotherapy.

If you are considering hypofractionated radiotherapy please consult your doctor for further information.