title: Comparison of image-guided radiotherapy technologies for prostate cancer.
abstract: Radiation oncology has seen a rapid increase in the use of image-guided radiotherapy technology (IGRT) for prostate cancer patients over the past decade. The increase in the use of IGRT is largely driven by the fact that these technologies have been approved by the Food and Drug Administration and are now readily reimbursed by many insurance companies. Prostate cancer patients undergoing intensity modulated radiotherapy (IMRT) now have access to a wide variety of IGRTs that can cost anywhere from $500,000 or more in upfront costs, and can add anywhere from 10 to 15 thousand dollars to a course of IMRT. Some of the IGRT options include daily cone beam computed tomography, ultrasound, orthogonal x-ray units using implanted fiducial markers, implanted radiofrequency markers with the ability to localize and track prostate motion during radiotherapy (Calypso 4D), and cine magnetic resonance imaging. Although these technologies add to the cost of IMRT, there is little direct comparative effectiveness data to help patients, physicians, and policy makers decide if one technology is better than another. In our critical review, the first of its kind, we summarize the advantages, disadvantages, and the limitations of each technology. We also provide an overview of existing literature as it pertains to the comparison of existing IGRTs. Lastly, we provide insights about the need for future outcomes research that may have a significant impact on health policies as it comes to reimbursement in the modern era.
authors: Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.
authors: Satya
authors: S
authors: Das
authors: Tian
authors: T
authors: Liu
authors: Ashesh B
authors: AB
authors: Jani
authors: Peter
authors: P
authors: Rossi
authors: Joseph
authors: J
authors: Shelton
authors: Zheng
authors: Z
authors: Shi
authors: Mohammad K
authors: MK
authors: Khan
mesh_terms: D054893:Cone-Beam Computed Tomography; D003362:Cost-Benefit Analysis; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000191:economics; D008297:Male; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000191:economics / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography / Q000191:economics