Outcomes similar for newer and older radiotherapy after prostatectomy

A recent study uncovered no significant differences in morbidity or recurrence rates between men with prostate cancer who underwent conformal radiotherapy (CRT) or those receiving newer intensity-modulated radiotherapy (IMRT) following prostatectomy.

Radiotherapy is indicated after prostatectomy in select patients with adverse pathologic features and in those with recurrent prostate cancer. Compared with the older technique of CRT, IMRT is a more expensive technology that may reduce radiation doses to adjacent organs, explained Ronald C. Chen, MD, MPH, assistant professor of radiation oncology at the University of North Carolina School of Medicine in Chapel Hill, and colleagues in JAMA Internal Medicine.  

To compare CRT and IMRT usage patterns and related disease control and morbidity outcomes, Chen's team identified men from Surveillance, Epidemiology, and End Results (SEER)–Medicare data with a diagnosis of prostate cancer. All patients had undergone CRT (557 men) or IMRT (457 men) within 3 years after radical prostatectomy, between 2002 and 2007. Outcomes were compared using the patients' Medicare claims through 2009.

Use of IMRT increased from zero in 2000 to 82.1% in 2009. No significant differences were seen between the CRT and IMRT groups in rates of long-term gastrointestinal morbidity, urinary nonincontinent morbidity, urinary incontinence, or erectile dysfunction, or in rates of subsequent treatment for recurrent disease.

These findings led Chen and coauthors to describe the potential clinical benefit of postprostatectomy IMRT as “unclear.” Acknowledging that formal analysis is needed, the group noted that postprostatectomy IMRT may not be cost-effective compared with CRT.
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