Comparative effectiveness of external-beam radiation approaches for prostate cancer.
Comparative effectiveness of external-beam radiation approaches for prostate cancer.
复制标题
DOI：
10.1016/j.eururo.2012.06.055
复制
发表时间：
2014-01
期刊：
影响因子：
23.4
通讯作者：
Hollenbeck BK
中科院分区：
文献类型：
--
作者：
Jacobs BL;Zhang Y;Skolarus TA;Wei JT;Montie JE;Miller DC;Hollenbeck BK
调强放疗（IMRT）越来越多地用于治疗局限性前列腺癌。虽然允许向前列腺输送更高剂量的辐射，但与现有标准三维适形治疗（3D-CRT）相比，其有效性尚不确定。研究调强放疗相对于三维适形放疗的有效性。我们使用监测、流行病学和最终结果（SEER）-医疗保险数据进行了一项基于人群的队列研究，以确定2001年至2007年期间接受3D-CRT（n= 6，976）或IMRT（n= 11，039）诊断为前列腺癌的男性。我们评估了我们的主要结果（即，使用考克斯比例风险模型，调整了雄激素剥夺治疗（ADT）补救治疗的使用和需要干预的并发症风险。接受调强放射治疗的男性比例从2001年的9%上升到2007年的93%。与接受3D-CRT治疗的患者相比，接受IMRT治疗的低风险患者使用ADT挽救治疗的可能性相似，发生需要干预的并发症的风险相似（均p>0.05）。相反，接受IMRT治疗但未同时接受ADT的高风险患者亚组不太可能使用挽救治疗（p=0.02），同时维持相似的并发症发生率。由于我们的队列包括医疗保险受益人，我们的研究结果可能无法推广到年轻患者。对于一部分高危患者，调强放射治疗在减少挽救治疗而不增加并发症方面显示出获益。对于其他患者，两种模式之间的挽救治疗和并发症风险相当。
Intensity-modulated radiotherapy (IMRT) is increasingly used for treating localized prostate cancer. While allowing for the delivery of higher doses of radiation to the prostate, its effectiveness compared to the prior standard, 3-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 (SEER)-Medicare data to identify men diagnosed with prostate cancer between 2001 and 2007 who underwent either 3D-CRT (n=6,976) or IMRT (n=11,039). We assessed our main outcomes (i.e., 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 to 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. Since 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.