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Study examines adverse effects among different radiation therapies for prostate cancer
Date:4/17/2012

used Surveillance, Epidemiology, and End Results-Medicare-linked data from 2000 through 2009 for patients with localized prostate cancer. The primary outcomes measured were rates of gastrointestinal adverse effects (such as rectal bleeding or diarrhea) and urinary adverse effects, erectile dysfunction, hip fractures, and receipt of additional cancer therapy as an indicator for disease recurrence.

The use of IMRT vs. conformal radiation therapy increased from 0.15 percent in 2000 to 95.9 percent in 2008. In the propensity-score adjusted analysis (n = 12,976), the researchers found that men treated with IMRT were less likely to receive a diagnosis of gastrointestinal adverse effects and hip fracture but more likely to receive a diagnosis of erectile dysfunction. Also, IMRT patients were nearly 20 percent less likely to receive additional cancer therapy.

In a propensity score-matched comparison between IMRT and proton therapy (n = 1,368), IMRT patients had a 34 percent lower risk of gastrointestinal adverse effects. There were no significant differences in rates of other adverse effects or additional therapies between IMRT and proton therapy.

"Proton therapy is a high-profile, high-cost prostate cancer treatment. Since 2007, multiple proton facilities have been built, and direct-to-consumer advertising is likely to lead to a substantial increase in use," the authors write. "Overall, our results do not clearly demonstrate a clinical benefit to support the recent increase in proton therapy use for prostate cancer."

The researchers add that the findings that patients receiving IMRT were less likely than those receiving conformal radiation therapy to undergo additional cancer treatments is consistent with the use of IMRT to deliver dose-escalated treatment, resulting in improved cancer control, as demonstrated by randomized trials. "Taken together, these results suggest that IMRT facilitated radiation dose escalation without compromisin
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Contact: Dianne Shaw
dgs@med.unc.edu
919-923-6012
JAMA and Archives Journals
Source:Eurekalert

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