title: Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Population-based study using Surveillance, Epidemiology, and End Results-Medicare-linked data from 2000 through 2009 for patients with nonmetastatic prostate cancer.
  
  
  METHODS
  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.
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Sheets
authors.forename: Gregg H
authors.initials: GH
authors.lastname: Goldin
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Meyer
authors.forename: Yang
authors.initials: Y
authors.lastname: Wu
authors.forename: YunKyung
authors.initials: Y
authors.lastname: Chang
authors.forename: Til
authors.initials: T
authors.lastname: Stürmer
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Holmes
authors.forename: Bryce B
authors.initials: BB
authors.lastname: Reeve
authors.forename: Paul A
authors.initials: PA
authors.lastname: Godley
authors.forename: William R
authors.initials: WR
authors.lastname: Carpenter
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Chen
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003625:Data Collection; D007172:Erectile Dysfunction / Q000209:etiology; D005767:Gastrointestinal Diseases / Q000209:etiology; D006620:Hip Fractures / Q000209:etiology; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009017:Morbidity; D057216:Propensity Score; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D061766:Proton Therapy; D011522:Protons / Q000009:adverse effects; D011832:Radiation Injuries; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D012306:Risk; D018426:SEER Program / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
chemical_list: D011522:Protons