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Comparative Study
. 2012 Apr 18;307(15):1611-20.
doi: 10.1001/jama.2012.460.

Intensity-modulated Radiation Therapy, Proton Therapy, or Conformal Radiation Therapy and Morbidity and Disease Control in Localized Prostate Cancer

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Free PMC article
Comparative Study

Intensity-modulated Radiation Therapy, Proton Therapy, or Conformal Radiation Therapy and Morbidity and Disease Control in Localized Prostate Cancer

Nathan C Sheets et al. JAMA. .
Free PMC article

Abstract

Context: There has been rapid adoption of newer radiation treatments such as intensity-modulated radiation therapy (IMRT) and proton therapy despite greater cost and limited demonstrated benefit compared with previous technologies.

Objective: To determine the comparative morbidity and disease control of IMRT, proton therapy, and conformal radiation therapy for primary prostate cancer treatment.

Design, setting, and patients: Population-based study using Surveillance, Epidemiology, and End Results-Medicare-linked data from 2000 through 2009 for patients with nonmetastatic prostate cancer.

Main outcome measures: Rates of gastrointestinal and urinary morbidity, erectile dysfunction, hip fractures, and additional cancer therapy.

Results: Use of IMRT vs conformal radiation therapy increased from 0.15% in 2000 to 95.9% in 2008. In propensity score-adjusted analyses (N = 12,976), men who received IMRT vs conformal radiation therapy were less likely to receive a diagnosis of gastrointestinal morbidities (absolute risk, 13.4 vs 14.7 per 100 person-years; relative risk [RR], 0.91; 95% CI, 0.86-0.96) and hip fractures (absolute risk, 0.8 vs 1.0 per 100 person-years; RR, 0.78; 95% CI, 0.65-0.93) but more likely to receive a diagnosis of erectile dysfunction (absolute risk, 5.9 vs 5.3 per 100 person-years; RR, 1.12; 95% CI, 1.03-1.20). Intensity-modulated radiation therapy patients were less likely to receive additional cancer therapy (absolute risk, 2.5 vs 3.1 per 100 person-years; RR, 0.81; 95% CI, 0.73-0.89). In a propensity score-matched comparison between IMRT and proton therapy (n = 1368), IMRT patients had a lower rate of gastrointestinal morbidity (absolute risk, 12.2 vs 17.8 per 100 person-years; RR, 0.66; 95% CI, 0.55-0.79). There were no significant differences in rates of other morbidities or additional therapies between IMRT and proton therapy.

Conclusions: Among patients with nonmetastatic prostate cancer, the use of IMRT compared with conformal radiation therapy was associated with less gastrointestinal morbidity and fewer hip fractures but more erectile dysfunction; IMRT compared with proton therapy was associated with less gastrointestinal morbidity.

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Stürmer reports receiving investigator-initiated research funding and support as principal investigator (RO1 AG023178) and coinvestigator (RO1 AG018833) from the National Institute on Aging at the National Institutes of Health (NIH), funding as principal investigator of the University of North Carolina (UNC) Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) center from the Agency for Healthcare Research and Quality, salary support from the UNC Center of Excellence in Pharmacoepidemiology and Public Health, consultancy on the Genentech CER advisory board, and from unrestricted research grants from Merck and sanofi-aventis to the UNC. Dr Godley reports receiving compensation for participating in the data and safety monitoring committee for Ferring Pharmaceuticals, which manufactures Degarelix, a hormonal treatment for prostate cancer that is not directly related to the subject of this study, and receiving compensation for consultancy with GlaxoSmithKline. No other disclosures were reported.

Figures

Figure 1
Figure 1
Propensity Score–Adjusted Rates of Additional Cancer Treatment for Patients Treated With Intensity-Modulated Radiation Therapy vs Conformal Radiation Therapy
Figure 2
Figure 2
Propensity Score–Matched Rates of Additional Cancer Treatment for Patients Treated With Intensity-Modulated Radiation Therapy vs Proton Therapy

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