Comparative Effectiveness of Intensity-Modulated Radiotherapy and Conventional Conformal Radiotherapy in the Treatment of Prostate Cancer After Radical Prostatectomy
Comparative Effectiveness of Intensity-Modulated Radiotherapy and Conventional Conformal Radiotherapy in the Treatment of Prostate Cancer After Radical Prostatectomy
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DOI：
10.1001/jamainternmed.2013.1020
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发表时间：
2013-06-24
影响因子：
39
通讯作者：
Chen, Ronald C.
中科院分区：
文献类型：
--
作者：
Goldin, Gregg H.;Sheets, Nathan C.;Chen, Ronald C.
重要性：前列腺癌治疗的比较有效性研究是必要的，因为新的和昂贵的治疗方法的发展和快速临床采用没有证明临床效益。放射治疗是指在选定的病人谁有不良的病理特征和复发性疾病切除术后。目的：为了检查调强放疗（IMRT）的使用模式，IMRT是一种更新、更昂贵的技术，与旧的适形放疗（CRT）相比，它可以减少肿瘤切除术后对邻近器官的辐射剂量，设计和设置：数据来自监测、流行病学和最终结果-医疗保险相关数据库，用于识别前列腺癌患者，这些患者在前列腺切除术后3年内接受过放疗。接受调强放疗或CRT的患者。主要结果和措施：2002年至2007年期间接受放疗的457例调强放疗和557例CRT患者的结果进行了比较，使用他们的索赔到2009年。我们使用倾向评分法来平衡基线特征，并估计调整后的发病率比（RR）及其95%CI为测量outcomes.Results：使用调强放射治疗从2000年的零增加到2009年的82.1%。接受调强放疗与CRT的男性在长期胃肠道发病率（RR，0.95; 95%CI，0.66-1.37）、尿失禁发病率（0.93; 0.66-1.33）、尿失禁（0.98; 0.71-1.35）或勃起功能障碍（0.85; 0.61-1.19）方面无显著差异。复发性疾病的后续治疗无显著差异（RR，1.31; 95%CI，0.90-1.92）。结论和相关性：乳腺癌切除术后IMRT和CRT实现了相似的发病率和癌症控制结果。IMRT在这种情况下的潜在临床益处尚不清楚。考虑到调强放射治疗更昂贵，与CRT相比，调强放射治疗用于乳腺癌切除术后放射治疗可能不具有成本效益，尽管需要进行正式分析。
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.