Radiation Treatments Show Similar Results in Prostate Cancer Patients After Surgery, AHRQ Study Finds

New research from AHRQ’s Effective Health Care Program finds that for prostate cancer patients who require radiotherapy following prostatectomy, the prostate cancer therapies intensity-modulated radiotherapy (IMRT) and conformal radiotherapy (CRT) achieved similar morbidity and cancer control results. Men who received IMRT versus CRT showed no significant difference in rates of long-term gastrointestinal morbidity, urinary nonincontinent morbidity, urinary incontinence, or erectile dysfunction. There was also no significant difference in subsequent treatment for recurrent disease. IMRT is a newer and more costly treatment option for postprostatectomy patients with adverse pathology results or recurrent disease. It remains unclear whether the potential benefits of a more focused radiation technique will be realized in terms of improving outcomes of men with localized prostate cancer. The report, titled Comparative Effectiveness of Intensity-Modulated Radiotherapy and Conventional Conformal Radiotherapy in the Treatment of Prostate Cancer After Radical Prostatectomy, appeared online May 20 in JAMA Internal Medicine. Select to access the abstract on PubMed.®

2013 May 20:1-8. doi: 10.1001/jamainternmed.2013.1020. [Epub ahead of print]

Comparative Effectiveness of Intensity-Modulated Radiotherapy and Conventional Conformal Radiotherapy in the Treatment of Prostate Cancer After Radical Prostatectomy.

Goldin GH, Sheets NC, Meyer AM, Kuo TM, Wu Y, Stürmer T, Godley PA, Carpenter WR, Chen RC.

Abstract

IMPORTANCE Comparative effectiveness research of prostate cancer therapies is needed because of the development and rapid clinical adoption of newer and costlier treatments without proven clinical benefit. Radiotherapy is indicated after prostatectomy in select patients who have adverse pathologic features and in those with recurrent disease. OBJECTIVES To examine the patterns of use of intensity-modulated radiotherapy (IMRT), a newer, more expensive technology that may reduce radiation dose to adjacent organs compared with the older conformal radiotherapy (CRT) in the postprostatectomy setting, and to compare disease control and morbidity outcomes of these treatments. DESIGN AND SETTING Data from the Surveillance, Epidemiology, and End Results-Medicare-linked database were used to identify patients with a diagnosis of prostate cancer who had received radiotherapy within 3 years after prostatectomy. PARTICIPANTS Patients who received IMRT or CRT. MAIN OUTCOMES AND MEASURES The outcomes of 457 IMRT and 557 CRT patients who received radiotherapy between 2002 and 2007 were compared using their claims through 2009. We used propensity score methods to balance baseline characteristics and estimate adjusted incidence rate ratios (RRs) and their 95% CIs for measured outcomes. RESULTS Use of IMRT increased from zero in 2000 to 82.1% in 2009. Men who received IMRT vs CRT showed no significant difference in rates of long-term gastrointestinal morbidity (RR, 0.95; 95% CI, 0.66-1.37), urinary nonincontinent morbidity (0.93; 0.66-1.33), urinary incontinence (0.98; 0.71-1.35), or erectile dysfunction (0.85; 0.61-1.19). There was no significant difference in subsequent treatment for recurrent disease (RR, 1.31; 95% CI, 0.90-1.92). CONCLUSIONS AND RELEVANCE Postprostatectomy IMRT and CRT achieved similar morbidity and cancer control outcomes. The potential clinical benefit of IMRT in this setting is unclear. Given that IMRT is more expensive, its use for postprostatectomy radiotherapy may not be cost-effective compared with CRT, although formal analysis is needed.