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Comparative effectiveness of external-beam radiation approaches for prostate cancer.

ABSTRACT: Intensity-modulated radiotherapy (IMRT) is increasingly used to treat localized prostate cancer. Although allowing for the delivery of higher doses of radiation to the prostate, its effectiveness compared with the prior standard three-dimensional conformal therapy (3D-CRT) is uncertain.To examine the comparative effectiveness of IMRT relative to 3D-CRT.We performed a population-based cohort study using Surveillance, Epidemiology, and End Results-Medicare data to identify men diagnosed with prostate cancer between 2001 and 2007 who underwent either 3D-CRT (n=6976) or IMRT (n=11 039).We assessed our main outcomes (ie, the adjusted use of salvage therapy with androgen-deprivation therapy [ADT] and risk of a complication requiring an intervention) using Cox proportional hazards models.The percentage of men receiving IMRT increased from 9% in 2001 to 93% in 2007. Compared with those treated with 3D-CRT, low-risk patients treated with IMRT had similar likelihoods of using salvage therapy with ADT and similar risks of having a complication requiring an intervention (all p>0.05). Conversely, a subset of higher risk patients treated with IMRT who did not receive concurrent ADT were less likely to use salvage therapy (p=0.02) while maintaining similar complication rates. Because our cohort includes Medicare beneficiaries, our findings may not be generalizable to younger patients.For a subset of higher risk patients, IMRT appears to show a benefit in terms of reduced salvage therapy without an increase in complications. For other patients, the risks of salvage therapy and complications are comparable between the two modalities.

SUBMITTER: Jacobs BL

PROVIDER: S-EPMC4128498 | biostudies-other | 2014 Jan

REPOSITORIES: biostudies-other

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Comparative effectiveness of external-beam radiation approaches for prostate cancer.

Jacobs Bruce L BL Zhang Yun Y Skolarus Ted A TA Wei John T JT Montie James E JE Miller David C DC Hollenbeck Brent K BK

European urology 20120706 1

<h4>Background</h4>Intensity-modulated radiotherapy (IMRT) is increasingly used to treat localized prostate cancer. Although allowing for the delivery of higher doses of radiation to the prostate, its effectiveness compared with the prior standard three-dimensional conformal therapy (3D-CRT) is uncertain.<h4>Objective</h4>To examine the comparative effectiveness of IMRT relative to 3D-CRT.<h4>Design, setting, and participants</h4>We performed a population-based cohort study using Surveillance, E ...[more]

PMID: 22790288

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Project description:BackgroundExternal beam radiotherapy is the recommended but expensive treatment option for localized prostate cancer. Prostate cancer is the most common cancer in men worldwide. A cost-effectiveness study is needed given the excessive cost of radiotherapy treatment and the high prevalence of prostate cancer. The aim of this systematic review was to assess and identify studies that examined model based economic evaluation of external beam radiation therapy for the treatment of localized prostate cancer.MethodsA systematic review of the published literature was conducted through MEDLINE, NHS EED (NHS Economic Evaluation Database), and Cochrane databases with a specific search strategy. The literatures were searched according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. At first 1046 citations were identified. The extracted files were imported into the Rayyan systematic review site for inclusion or exclusion based on the defined criteria. Studies included in this review were articles published between 2003 and 2017, and that conducted full-economic evaluations of the modality of external beam radiotherapy for the treatment of localized prostate cancer.ResultsThere were 12 studies that satisfied the inclusion and exclusion criteria. Seven studies compared intensity modulated radiation therapy (IMRT) with three-dimensional conformal radiation therapy (3D-CRT), two compared IMRT with stereotactic body radiation therapy (SBRT) another two-paper assessed IMRT with proton beam therapy (PBT). One paper compared the three external-beam radio therapy options of IMRT, SBRT and PBT. Most of the studies were originated from the US and analyzed the cost data from the payer's perspective. Most studies were supported that IMRT was cost effective when it compared with 3D-CRT. Compared with IMRT, SBRT was found to be cost-effective.ConclusionsThere are limited number of studies exist on the cost effectiveness of radiation therapy options for the treatment of localize prostate cancer across Europe. Most studies are originated from the US Medicare payer Perspective. Further research is need that investigate the cost effectiveness of these radiation therapy options from the societal perspective in Europe.

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Comparative effectiveness of external-beam radiation approaches for prostate cancer.

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Comparative effectiveness of external-beam radiation approaches for prostate cancer.

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