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Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer.

Publication ,  Journal Article
Sheets, NC; Goldin, GH; Meyer, A-M; Wu, Y; Chang, Y; Stürmer, T; Holmes, JA; Reeve, BB; Godley, PA; Carpenter, WR; Chen, RC
Published in: JAMA
April 18, 2012

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.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

April 18, 2012

Volume

307

Issue

15

Start / End Page

1611 / 1620

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • SEER Program
  • Risk
  • Radiotherapy, Intensity-Modulated
  • Radiotherapy, Conformal
  • Radiation Injuries
  • Protons
  • Proton Therapy
  • Prostatic Neoplasms
 

Citation

APA
Chicago
ICMJE
MLA
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Sheets, N. C., Goldin, G. H., Meyer, A.-M., Wu, Y., Chang, Y., Stürmer, T., … Chen, R. C. (2012). Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer. JAMA, 307(15), 1611–1620. https://doi.org/10.1001/jama.2012.460
Sheets, Nathan C., Gregg H. Goldin, Anne-Marie Meyer, Yang Wu, YunKyung Chang, Til Stürmer, Jordan A. Holmes, et al. “Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer.JAMA 307, no. 15 (April 18, 2012): 1611–20. https://doi.org/10.1001/jama.2012.460.
Sheets NC, Goldin GH, Meyer A-M, Wu Y, Chang Y, Stürmer T, et al. Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer. JAMA. 2012 Apr 18;307(15):1611–20.
Sheets, Nathan C., et al. “Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer.JAMA, vol. 307, no. 15, Apr. 2012, pp. 1611–20. Pubmed, doi:10.1001/jama.2012.460.
Sheets NC, Goldin GH, Meyer A-M, Wu Y, Chang Y, Stürmer T, Holmes JA, Reeve BB, Godley PA, Carpenter WR, Chen RC. Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer. JAMA. 2012 Apr 18;307(15):1611–1620.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

April 18, 2012

Volume

307

Issue

15

Start / End Page

1611 / 1620

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • SEER Program
  • Risk
  • Radiotherapy, Intensity-Modulated
  • Radiotherapy, Conformal
  • Radiation Injuries
  • Protons
  • Proton Therapy
  • Prostatic Neoplasms