title: Use, complications, and costs of stereotactic body radiotherapy for localized prostate cancer.
abstract: Stereotactic body radiotherapy (SBRT) for localized prostate cancer has potential advantages over traditional radiotherapies. Herein, the authors compared national trends in use, complications, and costs of SBRT with those of traditional radiotherapies.
  
  
  
  The authors identified men who underwent SBRT, intensity-modulated radiotherapy (IMRT), brachytherapy, and proton beam therapy as primary treatment of prostate cancer between 2004 and 2011 from Surveillance, Epidemiology, and End Results Program (SEER)-Medicare linked data. Temporal trend of therapy use was assessed using the Cochran-Armitage test. Two-year outcomes were compared using the chi-square test. Median treatment costs were compared using the Kruskal-Wallis test.
  
  
  
  A total of 542 men received SBRT, 9647 received brachytherapy, 23,408 received IMRT, and 800 men were treated with proton beam therapy. There was a significant increase in the use of SBRT and proton beam therapy (P<.001), whereas brachytherapy use decreased (P<.001). A higher percentage of patients treated with SBRT and brachytherapy had low-grade cancer (Gleason score ≤ 6 vs ≥ 7) compared with individuals treated with IMRT and proton beam therapy (54.0% and 64.2% vs 35.2% and 49.6%, respectively; P<.001). SBRT compared with brachytherapy and IMRT was associated with equivalent gastrointestinal toxicity but more erectile dysfunction at 2-year follow-up (P<.001). SBRT was associated with more urinary incontinence compared with IMRT and proton beam therapy but less compared with brachytherapy (P<.001, respectively). The median cost of SBRT was $27,145 compared with $17,183 for brachytherapy, $37,090 for IMRT, and $54,706 for proton beam therapy (P<.001).
  
  
  
  The use of SBRT and proton beam therapy for localized prostate cancer has increased over time. Despite men of lower disease stage undergoing SBRT, SBRT was found to be associated with greater toxicity but lower health care costs compared with IMRT and proton beam therapy. Cancer 2016;122:2496-504. © 2016 American Cancer Society.
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Halpern
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
authors.forename: Art
authors.initials: A
authors.lastname: Sedrakyan
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Hsu
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
authors.forename: Jialin
authors.initials: J
authors.lastname: Mao
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Daskivich
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Department of Radiation Oncology, Weill Cornell Medical College, New York, New York.
authors.forename: Encouse B
authors.initials: EB
authors.lastname: Golden
authors.affiliation: Department of Radiation Oncology, Weill Cornell Medical College, New York, New York.
authors.forename: Josephine
authors.identifier: 0000-0003-4807-5362
authors.initials: J
authors.lastname: Kang
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000532:radiotherapy*; D061766:Proton Therapy; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D012307:Risk Factors; D018426:SEER Program
keywords: health care costs; prostate cancer; proton beam therapy; radiosurgery; radiotherapy; stereotactic body radiotherapy; toxicity