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

• Published in: JAMA : the journal of the American Medical Association Vol. 307; no. 15; pp. 1611 - 1620
• Main Authors: Sheets, Nathan C, Goldin, Gregg H, Meyer, Anne-Marie, Wu, Yang, Chang, YunKyung, Stürmer, Til, Holmes, Jordan A, Reeve, Bryce B, Godley, Paul A, Carpenter, William R, Chen, Ronald C
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 18-04-2012
• Subjects: Aged; Biological and medical sciences; Clinical outcomes; Cohort Studies; Data Collection; Epidemiology; Erectile Dysfunction - etiology; Gastrointestinal Diseases - etiology; General aspects; Hip Fractures - etiology; Humans; Male; Medical sciences; Medicare - statistics & numerical data; Mens health; Morbidity; Nephrology. Urinary tract diseases; Propensity Score; Prostate cancer; Prostatic Neoplasms - radiotherapy; Proton Therapy; Protons - adverse effects; Public health. Hygiene; Public health. Hygiene-occupational medicine; Radiation Injuries; Radiation therapy; Radiotherapy, Conformal - adverse effects; Radiotherapy, Conformal - methods; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Risk; SEER Program - statistics & numerical data; Treatment Outcome; Tumors of the urinary system; United States; Urinary tract. Prostate gland; Urinary system disease; Prostate disease; Disease; Check; Early stage; Malignant tumor; Proton therapy; Epidemiology; Morbidity; Medicine; Conformal radiotherapy; Intensity modulated radiotherapy; Treatment; Surveillance; Male genital diseases; Prostate cancer; Cancer
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2012.460

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.