IMRT linked with less GI morbidity vs. conformal radiation

April 25, 2012

Compared with conformal radiation therapy, intensity-modulated radiation therapy (IMRT) was associated with fewer diagnoses of gastrointestinal adverse effects, hip fractures, and receipt of additional cancer treatments but more cases of erectile dysfunction in an analysis of three different types of radiation therapy used to treat localized prostate cancer.

Compared with conformal radiation therapy, intensity-modulated radiation therapy (IMRT) was associated with fewer diagnoses of gastrointestinal adverse effects, hip fractures, and receipt of additional cancer treatments but more cases of erectile dysfunction in an analysis of three different types of radiation therapy used to treat localized prostate cancer.

Proton therapy was associated with more GI adverse effects than IMRT.

The University of North Carolina, Chapel Hill study, originally reported at the 2012 Genitourinary Cancers Symposium in San Francisco and published last week in JAMA (2012; 307:1611-20), also found a "rapid and near-complete" adoption of IMRT for radiation for prostate cancer between 2000 and 2008, as well as significantly increased costs for new technologies for the disease.

Senior author Ronald C. Chen, MD, MPH, was asked at a JAMA media briefing in Washington whether IMRT could be justified given that the study shows that some morbidities don’t seem to be very different between conformal radiation and IMRT.

"I think that we have to prove effectiveness first before bringing costs into the equation," Dr. Chen responded.

Dr. Chen said he and colleagues are studying that issue now, using the Surveillance, Epidemiology and End Results Medicare linked data from 2000 through 2007, which his group is using to identify the records of 12,976 men getting IMRT or conformal radiation in the recent study. The current work may be submitted for publication by the end of the year, he noted in a later interview.

Dr. Chen also pointed to a prospective study of potentially more than 1,000 patients that UNC is beginning on quality of life, cancer control, cure rates, and survival in patients who choose different types of prostate cancer treatment and who are followed for 5 years or more.

That work and other current, large studies on prostate radiation treatment will hopefully give a better understanding of the field in upcoming years, he said.

The study was funded by the Agency for Healthcare Research and Quality.

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