Post-RP IMRT may not be more effective than CRT

Intensity-modulated radiation therapy may not be more effective than conformal radiation therapy in patients who have undergone radical prostatectomy, say researchers from the University of North Carolina, Chapel Hill.

In a comparative effectiveness study published online in JAMA Internal Medicine (May 20, 2013), the authors evaluated the long-term outcomes of prostate cancer patients who received radiation treatments following prostatectomy using conformal radiation therapy (CRT) or the newer intensity-modulated radiation therapy (IMRT). Lead author Ronald Chen, MD, MPH, said the results showed little difference in the long-term health of patients who used the older and newer radiation therapies.

"Many prostate cancer patients need radiation treatment after prostatectomy, either because the cancer is aggressive or for recurrence. In prostate cancer, we have seen a trend in our health care system where new technologies are adopted quickly, maybe because there is a belief that newer treatments are better, but often there is a lack of studies to actually compare patient outcomes from older versus newer treatments," said Dr. Chen.

The authors used Medicare data to compare the outcomes of 557 CRT and 457 IMRT patients treated between 2002 and 2007. The patients, 66 years of age or older who underwent radical prostatectomy and subsequent radiation therapy within 3 years of their surgery, showed no difference in terms of urinary side effects, bowel side effects, sexual dysfunction, and other long-term side effects or cancer control.

"For patients with newly diagnosed prostate cancer who have chosen to receive curative radiation treatment, our prior study showed that IMRT was associated with less long-term side effects and better cancer control than CRT. However, for patients who have had a prostatectomy already, and subsequently need radiation treatment, this study shows that IMRT and CRT seemed to have similar outcomes," said Dr. Chen.

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