Intensity-Modulated Radiation Therapy, Proton Therapy, or Conformal Radiation Therapy and Morbidity and Disease Control in Localized Prostate Cancer
Intensity-Modulated Radiation Therapy, Proton Therapy, or Conformal Radiation Therapy and Morbidity and Disease Control in Localized Prostate Cancer
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DOI：
10.1001/jama.2012.460
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发表时间：
2012-04-18
影响因子：
120.7
通讯作者：
Chen, Ronald C.
中科院分区：
文献类型：
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作者：
Sheets, Nathan C.;Goldin, Gregg H.;Chen, Ronald C.
尽管与以前的技术相比，调强放射治疗（IMRT）和质子治疗的成本更高，且证明的效益有限，但新的放射治疗已被迅速采用。目的比较IMRT、质子治疗和适形放疗治疗原发性前列腺癌的发病率和病情控制情况。设计、设置和基于患者人群的研究，使用监测、流行病学和最终结果- 2000年至2009年非转移性前列腺癌患者的医疗保险相关数据。主要结局指标：胃肠道和泌尿系统发病率、勃起功能障碍、髋部骨折和其他癌症治疗的发生率。结果IMRT与适形放疗的比值从2000年的0.15%上升到2008年的95.9%。在倾向评分调整分析（N= 12,976）中，接受IMRT与符合放射治疗的男性更不可能被诊断为胃肠道疾病（绝对风险，13.4 vs 14.7 / 100人-年；相对风险[RR]， 0.91; 95% CI, 0.86-0.96）和髋部骨折（绝对风险，0.8 vs 1.0 / 100人-年；RR, 0.78; 95% CI, 0.65-0.93），但更可能被诊断为勃起功能障碍(绝对风险，5.9 vs 5.3 / 100人-年；RR, 1.12；95% ci, 1.03-1.20)。调强放疗患者接受额外癌症治疗的可能性较小（绝对风险，2.5 vs 3.1 / 100人-年；RR, 0.81; 95% CI, 0.73-0.89）。在IMRT和质子治疗的倾向评分匹配比较中（n=1368）， IMRT患者的胃肠道发病率较低（绝对风险，12.2 vs 17.8 / 100人-年；RR, 0.66; 95% CI, 0.55-0.79）。IMRT和质子治疗在其他发病率或额外治疗方面没有显著差异。结论：在非转移性前列腺癌患者中，与适形放疗相比，使用IMRT与胃肠道发病率和髋部骨折发生率较低相关，但勃起功能障碍发生率较高；与质子治疗相比，IMRT的胃肠道发病率较低。《美国医学协会杂志》上。2012年;307 (15): 1611 - 1620
Context There has been rapid adoption of newer radiation treatments such as intensity-modulated radiation therapy (IMRT) and proton therapy despite greater cost and limited demonstrated benefit compared with previous technologies.Objective To determine the comparative morbidity and disease control of IMRT, proton therapy, and conformal radiation therapy for primary prostate cancer treatment.Design, Setting, and Patients Population-based study using Surveillance, Epidemiology, and End Results-Medicare-linked data from 2000 through 2009 for patients with nonmetastatic prostate cancer.Main Outcome Measures Rates of gastrointestinal and urinary morbidity, erectile dysfunction, hip fractures, and additional cancer therapy.Results Use of IMRT vs conformal radiation therapy increased from 0.15% in 2000 to 95.9% in 2008. In propensity score-adjusted analyses (N=12 976), men who received IMRT vs conformal radiation therapy were less likely to receive a diagnosis of gastrointestinal morbidities (absolute risk, 13.4 vs 14.7 per 100 person-years; relative risk [RR], 0.91; 95% CI, 0.86-0.96) and hip fractures (absolute risk, 0.8 vs 1.0 per 100 person-years; RR, 0.78; 95% CI, 0.65-0.93) but more likely to receive a diagnosis of erectile dysfunction (absolute risk, 5.9 vs 5.3 per 100 person-years; RR, 1.12; 95% CI, 1.03-1.20). Intensity-modulated radiation therapy patients were less likely to receive additional cancer therapy (absolute risk, 2.5 vs 3.1 per 100 person-years; RR, 0.81; 95% CI, 0.73-0.89). In a propensity score-matched comparison between IMRT and proton therapy (n=1368), IMRT patients had a lower rate of gastrointestinal morbidity (absolute risk, 12.2 vs 17.8 per 100 person-years; RR, 0.66; 95% CI, 0.55-0.79). There were no significant differences in rates of other morbidities or additional therapies between IMRT and proton therapy.Conclusions Among patients with nonmetastatic prostate cancer, the use of IMRT compared with conformal radiation therapy was associated with less gastrointestinal morbidity and fewer hip fractures but more erectile dysfunction; IMRT compared with proton therapy was associated with less gastrointestinal morbidity. JAMA. 2012;307(15):1611-1620