Comparative Toxicities and Cost of Intensity-Modulated Radiotherapy, Proton Radiation, and Stereotactic Body Radiotherapy Among Younger Men With Prostate Cancer
Comparative Toxicities and Cost of Intensity-Modulated Radiotherapy, Proton Radiation, and Stereotactic Body Radiotherapy Among Younger Men With Prostate Cancer
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DOI：
10.1200/jco.2017.75.5371
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发表时间：
2018-06-20
影响因子：
45.3
通讯作者：
Smith, Benjamin D.
中科院分区：
文献类型：
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作者：
Pan, Hubert Y.;Jiang, Jing;Smith, Benjamin D.
目的比较65岁以下有私人保险男性前列腺癌患者质子放射和立体定向放射治疗（SBRT）与调强放疗（IMRT）的毒性和费用。方法使用MarketScan商业索赔和Encounters数据库，我们确定了2008年至2015年间因前列腺癌接受放射治疗的男性。在临床和社会人口因素的基础上，接受质子治疗和SBRT的患者与IMRT患者进行倾向评分匹配。比例风险模型比较了不同治疗的尿、肠和勃起功能障碍毒性的累积发生率。从付款人的角度来看，费用是根据索赔计算的，并调整为2015年的美元。结果693例质子治疗患者与3465例IMRT患者相匹配。质子治疗患者发生复合尿毒性（33% vs 42%， 2年，P < 0.001）和勃起功能障碍（21% vs 28%， 2年，P < 0.001）的风险较低，但发生肠毒性的风险较高（20% vs 15%， 2年，P = 0.02）。质子治疗患者的平均放射费用为115,501美元，IMRT患者的平均放射费用为59,012美元（P < 0.001）。共有310名SBRT患者与3100名IMRT患者相匹配。SBRT和IMRT患者在泌尿、肠道或勃起功能障碍的综合毒性方面没有显著差异（P < 0.05），尽管SBRT组尿瘘的风险更高（2年时为1% vs 0.1%; P = 0.009）。SBRT的平均放射费用为49,504美元，IMRT为57,244美元（P < 0.001）。结论：在年轻前列腺癌患者中，质子辐射与尿毒性显著降低相关，但增加了肠道毒性，其成本几乎是IMRT的两倍。SBRT和IMRT具有相似的毒性特征；SBRT的费用略低于IMRT。
PurposeTo compare the toxicities and cost of proton radiation and stereotactic body radiotherapy (SBRT) with intensity-modulated radiotherapy (IMRT) for prostate cancer among men younger than 65 years of age with private insurance.MethodsUsing the MarketScan Commercial Claims and Encounters database, we identified men who received radiation for prostate cancer between 2008 and 2015. Patients undergoing proton therapy and SBRT were propensity score-matched to IMRT patients on the basis of clinical and sociodemographic factors. Proportional hazards models compared the cumulative incidence of urinary, bowel, and erectile dysfunction toxicities by treatment. Cost from a payer's perspective was calculated from claims and adjusted to 2015 dollars.ResultsA total of 693 proton therapy patients were matched to 3,465 IMRT patients. Proton therapy patients had a lower risk of composite urinary toxicity (33% v 42% at 2 years; P < .001) and erectile dysfunction (21% v 28% at 2 years; P < .001), but a higher risk of bowel toxicity (20% v 15% at 2 years; P = .02). Mean radiation cost was $115,501 for proton therapy patients and $59,012 for IMRT patients (P < .001). A total of 310 SBRT patients were matched to 3,100 IMRT patients. There were no significant differences in composite urinary, bowel, or erectile dysfunction toxicities between SBRT and IMRT patients (P > .05), although a higher risk of urinary fistula was noted with SBRT (1% v 0.1% at 2 years; P = .009). Mean radiation cost for SBRT was $49,504 and $57,244 for IMRT (P < .001).ConclusionAmong younger men with prostate cancer, proton radiation was associated with significant reductions in urinary toxicity but increased bowel toxicity at nearly twice the cost of IMRT. SBRT and IMRT were associated with similar toxicity profiles; SBRT was modestly less expensive than IMRT.