Radiation Therapy Modalities for Prostate Cancer

Deville, Curtiland; Ben‐Josef, Edgar; Vapiwala, Neha

doi:10.1001/jama.2012.8110

Cited by 7 publications

(5 citation statements)

References 4 publications

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Section: Discussionmentioning

confidence: 99%

“…6 Although claims-based reports offer the enticing power of numbers, there are multiple well described limitations to substituting insurance codes for primary source data, because only the latter can accurately provide and control for radiation dose, treatment volume, and actual clinical events. 24 Limitations of this report include its retrospective analysis of a nonrandomized, mixed cohort of patients. However, we rigorously matched patients in an attempt to minimize the effect of confounding factors.…”

Section: Late Toxicitymentioning

confidence: 99%

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A case‐matched study of toxicity outcomes after proton therapy and intensity‐modulated radiation therapy for prostate cancer

Fang

Mick

Deville

et al. 2014

Cancer

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BACKGROUND The authors assessed whether proton beam therapy (PBT) for prostate cancer (PCa) was associated with differing toxicity compared with intensity-modulated radiation therapy (IMRT) using case-matched analysis. METHODS From 2010 to 2012, 394 patients who had localized PCa received 79.2 Gray (Gy) relative biologic effectiveness (RBE) delivered with either PBT (181 patients) or IMRT (213 patients). Patients were case-matched on risk group, age, and prior gastrointestinal (GI) and genitourinary (GU) disorders, resulting in 94 matched pairs. Both exact matching (risk group) and nearest-neighbor matching (age, prior GI/GU disorders) were used. Residual confounding was adjusted for by using multivariable regression. Maximum acute and late GI/GU Common Terminology Criteria for Adverse Events-graded toxicities were compared using univariate and multivariable logistic and Cox regression models, respectively. RESULTS Bladder and rectum dosimetry variables were significantly lower for PBT versus IMRT (P ≤ .01). The median follow-up was 47 months (range, 5–65 months) for patients who received IMRT and 29 months (range, 5–50 months) for those who received PBT. On multivariable analysis, which exploited case matching and included direct adjustment for confounders and independent predictors, there were no statistically significant differences between IMRT and PBT in the risk of grade ≥2 acute GI toxicity (odds ratio, 0.27; 95% confidence interval [CI], 0.06–1.24; P = .09), grade ≥2 acute GU toxicity (odds ratio, 0.69; 95% CI, 0.32–1.51; P = .36), grade ≥2 late GU toxicity (hazard ratio, 0.56; 95% CI, 0.22–1.41; P = .22), and grade ≥2 late GI toxicity (hazard ratio, 1.24; 95% CI, 0.53–2.94; P = .62). CONCLUSIONS In this matched comparison of prospectively collected toxicity data on patients with PCa who received treatment with contemporary IMRT and PBT techniques and similar dose-fractionation schedules, the risks of acute and late GI/GU toxicities did not differ significantly after adjustment for confounders and predictive factors.

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Section: Discussionmentioning

confidence: 99%

Section: Late Toxicitymentioning

confidence: 99%

A case‐matched study of toxicity outcomes after proton therapy and intensity‐modulated radiation therapy for prostate cancer

Fang

Mick

Deville

et al. 2014

Cancer

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“…[4][5][6][7] The use of Medicare claims rather than medical records may be a weakness, because medical claims codes identify interventions that may not reflect the relevant endpoints of disease control, specific treatment-related toxicity, or patient-reported quality of life (QOL). Some of the reports have attracted considerable criticism, 8,9 and the authors of 1 study acknowledge the limitations of the Medicare database and the need for patient-reported QOL outcomes. 7 A randomized trial comparing PT and IMRT has been opened, but the comparative impact on late effects will not be known for some years (registered as National Clinical Trial NCT01617161).…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness study of patient‐reported outcomes after proton therapy or intensity‐modulated radiotherapy for prostate cancer

Hoppe

Michalski

Mendenhall

et al. 2013

Cancer

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Background Data continues to emerge on the relative merits of different treatment modalities for prostate cancer. The purpose of this study is to compare patient-reported quality-of-life outcomes (QOL) after proton therapy (PT) and intensity-modulated radiation therapy (IMRT) for prostate cancer. Methods A comparison was performed of prospectively collected QOL data using the expanded prostate cancer index (EPIC) questionnaire. QOL data was collected during the first 2 years following treatment for men treated with PT and IMRT. PT was delivered to 1,243 men at a single center to 76-82Gy. IMRT was delivered to 204 men included in the Prostate Cancer Quality Assurance Study (PROSTQA) in doses of 75.6-79.4Gy.The Wilcoxon rank sum test was used to compare EPIC outcomes by modality using baseline-adjusted scores at different time points. Individual questions were assessed by converting to binary outcomes and testing with generalized estimating equations. Results No differences in changes in summary scores for bowel, urinary incontinence, urinary irritative/obstructive, and sexual domains were seen between the two cohorts. However, more men treated with IMRT reported moderate/big problems with rectal urgency (p=0.02) and frequent bowel movements (p=0.05) than men treated with PT. Conclusions There were no differences in QOL summary scores between the IMRT and PT cohorts during early follow-up up to 2-years. Response to individual questions suggests possible differences in specific bowel symptoms between the two cohorts. These outcomes highlight the need for further comparative studies of PT and IMRT.

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“…The results of the Sheets and colleague's study found that IMRT was associated with less gastrointestinal (GI) morbidity than PT. Following publication of the study by Sheets and colleagues, several letters 8,9 and additional publications 10,11 suggested that patients who received PT may be subject to surveillance bias because they are more closely followed and likely to receive screening colonoscopies. This may lead to 2 kinds of problems: first, if the screening procedure cannot be separated from diagnostic procedures that are included in the definition of the outcome of interest (colon toxicities), this will lead to a greater incidence of colon toxicities in the proton population compared with alternative treatment strategies.…”

mentioning

confidence: 99%

“…Second, even if the colonoscopies do not identify acute outcomes, increased screening could still lead to a higher incidence of some toxicities because of detection of preclinical toxicities. Finally, there were additional questions regarding the choices of procedure codes used to define the outcome, 8,9,12 which introduces the potential for misclassification because of choices of codes and the issues surrounding screening colonoscopies.…”

mentioning

confidence: 99%