title: The early adoption of intensity-modulated radiotherapy and stereotactic body radiation treatment among older Medicare beneficiaries with prostate cancer.
abstract: BACKGROUND
  Several new prostate cancer treatments have emerged since 2000, including 2 radiotherapies with similar efficacy at the time of their introduction: intensity-modulated radiotherapy (IMRT) and stereotactic body radiation therapy (SBRT). The objectives of this study were to compare their early adoption patterns and identify factors associated with their use.
  
  
  METHODS
  By using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, patients who received radiation therapy during the 5 years after IMRT introduction (2001-2005) and the 5 years after SBRT introduction (2007-2011) were identified. The outcome of interest was the receipt of new radiation therapy (ie, IMRT or SBRT) compared with the existing standard radiation therapies at that time. The authors fit a series of multivariable, hierarchical logistic regression models accounting for patients nested within health service areas to examine the factors associated with the receipt of new radiation therapy.
  
  
  RESULTS
  During 2001 to 2005, 5680 men (21%) received IMRT compared with standard radiation (n = 21,555). Men who received IMRT were older, had higher grade tumors, and lived in more populated areas (P < .05). During 2007 through 2011, 595 men (2%) received SBRT compared with standard radiation (n = 28,255). Men who received ng SBRT were more likely to be white, had lower grade tumors, lived in more populated areas, and were more likely to live in the Northeast (P < .05). Adjusting for cohort demographic and clinical factors, the early adoption rate for IMRT was substantially higher than that for SBRT (44% vs 4%; P < .01).
  
  
  CONCLUSIONS
  There is a stark contrast in the adoption rates of IMRT and SBRT at the time of their introduction. Further investigation of the nonclinical factors associated with this difference is warranted. Cancer 2017;123:2945-54. © 2017 American Cancer Society.
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.|Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.affiliation: Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania.|Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Yabes
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Samia H
authors.initials: SH
authors.lastname: Lopa
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Chung-Chou H
authors.initials: CH
authors.lastname: Chang
authors.affiliation: White River Junction Veterans Affairs Medical Center and The Dartmouth Institute Geisel School of Medicine, Lebanon, New Hampshire.
authors.forename: Florian R
authors.initials: FR
authors.lastname: Schroeck
authors.affiliation: Department of Radiation Oncology, Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.|Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Justin E
authors.initials: JE
authors.lastname: Bekelman
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
authors.affiliation: Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Nelson
authors.affiliation: Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania.|Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Health Policy Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Amber E
authors.initials: AE
authors.lastname: Barnato
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D016634:Radiosurgery / Q000706:statistics & numerical data*; D050397:Radiotherapy, Intensity-Modulated / Q000706:statistics & numerical data*; D018426:SEER Program; D014481:United States
keywords: adoption; intensity-modulated radiotherapy; prostate cancer; stereotactic body radiation treatment; technology