Stereotactic Body Radiation Therapy Versus Intensity-Modulated Radiation Therapy for Prostate Cancer: Less Cost at the Expense of More Genitourinary Toxicity Is a Concerning But Testable Hypothesis

D’Amico, Anthony V.

doi:10.1200/jco.2014.55.2380

Cited by 16 publications

(18 citation statements)

References 20 publications

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“…SBRT patients had increased GI billing claims at 6-months, with no differences at 12 and 24-months, and increased GU billing claims at all time-points. These data are consistent with transient urinary irritation flares post-treatment in early institutional SBRT trials, though the rates of GI and GU billing claims were higher than generally reported [10]. These early concerns about excess urinary toxicity prompted technique adjustments at the early SBRT trial institutions.…”

Section: Discussionsupporting

confidence: 87%

“…Stereotactic body radiotherapy (SBRT) has been increasingly used for prostate cancer, although some have expressed concerns about increased toxicity compared to IMRT [9,10]. Presented here is the largest pooled analysis of brachytherapy, IMRT, and SBRT patient-reported QOL across multiple institutions using the same QOL instrument.…”

Section: Discussionmentioning

confidence: 96%

“…Convenience, non-invasiveness, and cost effectiveness are leading to increasing SBRT use nationally [9], though concerns about SBRT toxicity remain [10]. A recent phase I/II dose-escalation trial reported 9.8% grade 3-4 rectal toxicity at the highest dose level (50 Gy in 5 fractions) [11], and a retrospective study of Medicare claims data showed genitourinary (GU) complications and a transient GI toxicity were more common with SBRT [9].…”

Section: Introductionmentioning

confidence: 99%

“…Single-institution SBRT trials show PSA control equivalent to IMRT or brachytherapy after short follow-up [6]. Cost-effectiveness analyses show SBRT is less expensive than IMRT [7], though brachytherapy is less expensive than both [8].Convenience, non-invasiveness, and cost effectiveness are leading to increasing SBRT use nationally [9], though concerns about SBRT toxicity remain [10]. A recent phase I/II dose-escalation trial reported 9.8% grade 3-4 rectal toxicity at the highest dose level (50 Gy in 5 fractions) [11], and a retrospective study of Medicare claims data showed genitourinary (GU) complications and a transient GI toxicity were more common with SBRT [9].…”

mentioning

confidence: 99%

See 3 more Smart Citations

Patient-reported quality of life after stereotactic body radiotherapy (SBRT), intensity modulated radiotherapy (IMRT), and brachytherapy

Evans

Zhao

Daignault

et al. 2015

Radiotherapy and Oncology

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Patient-reported quality of life after stereotactic body radiotherapy (SBRT), intensity modulated radiotherapy (IMRT), and brachytherapy

Evans

Zhao

Daignault

et al. 2015

Radiotherapy and Oncology

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“…A study of 36.25 Gy/5 fractions delivered using Cyberknife demonstrated late grade 2 GU and GI toxicity of 5% and 2%, respectively, with 3.5% late grade 3 GU toxicity but no late grade 3 GI effects after a median follow-up of 2.7 years (19). With 6 years of follow-up, Katz (53). For those studies including pelvic nodal radiation with conventional fractionation, late toxicity with conventional or moderately hypofractionated radiation therapy delivered to the prostate is in the range of 5% (1,40).…”

Section: Discussionmentioning

confidence: 98%

A Phase 1/2 Trial of Brief Androgen Suppression and Stereotactic Radiation Therapy (FASTR) for High-Risk Prostate Cancer

Bauman

Ferguson

Lock

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer

et al. 2019

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Importance Stereotactic body radiotherapy harnesses improvements in technology to allow the completion of a course of external beam radiotherapy treatment for prostate cancer in the span of 4 to 5 treatment sessions. Although mounting short-term data support this approach, long-term outcomes have been sparsely reported. Objective To assess long-term outcomes after stereotactic body radiotherapy for low-risk and intermediate-risk prostate cancer. Design, Setting, and Participants This cohort study analyzed individual patient data from 2142 men enrolled in 10 single-institution phase 2 trials and 2 multi-institutional phase 2 trials of stereotactic body radiotherapy for low-risk and intermediate-risk prostate cancer between January 1, 2000, and December 31, 2012. Statistical analysis was performed based on follow-up from January 1, 2013, to May 1, 2018. Main Outcomes and Measures The cumulative incidence of biochemical recurrence was estimated using a competing risk framework. Physician-scored genitourinary and gastrointestinal toxic event outcomes were defined per each individual study, generally by Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events scoring systems. After central review, cumulative incidences of late grade 3 or higher toxic events were estimated using a Kaplan-Meier method. Results A total of 2142 men (mean [SD] age, 67.9 [9.5] years) were eligible for analysis, of whom 1185 (55.3%) had low-risk disease, 692 (32.3%) had favorable intermediate-risk disease, and 265 (12.4%) had unfavorable intermediate-risk disease. The median follow-up period was 6.9 years (interquartile range, 4.9-8.1 years). Seven-year cumulative rates of biochemical recurrence were 4.5% (95% CI, 3.2%-5.8%) for low-risk disease, 8.6% (95% CI, 6.2%-11.0%) for favorable intermediate-risk disease, 14.9% (95% CI, 9.5%-20.2%) for unfavorable intermediate-risk disease, and 10.2% (95% CI, 8.0%-12.5%) for all intermediate-risk disease. The crude incidence of acute grade 3 or higher genitourinary toxic events was 0.60% (n = 13) and of gastrointestinal toxic events was 0.09% (n = 2), and the 7-year cumulative incidence of late grade 3 or higher genitourinary toxic events was 2.4% (95% CI, 1.8%-3.2%) and of late grade 3 or higher gastrointestinal toxic events was 0.4% (95% CI, 0.2%-0.8%). Conclusions and Relevance In this study, stereotactic body radiotherapy for low-risk and intermediate-risk disease was associated with low rates of severe toxic events and high rates of biochemical control. These data suggest that stereotactic body radiotherapy is an appropriate definitive treatment modality for low-risk and intermediate-risk prostate cancer.

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Stereotactic Body Radiation Therapy Versus Intensity-Modulated Radiation Therapy for Prostate Cancer: Less Cost at the Expense of More Genitourinary Toxicity Is a Concerning But Testable Hypothesis

Cited by 16 publications

References 20 publications

Patient-reported quality of life after stereotactic body radiotherapy (SBRT), intensity modulated radiotherapy (IMRT), and brachytherapy

Patient-reported quality of life after stereotactic body radiotherapy (SBRT), intensity modulated radiotherapy (IMRT), and brachytherapy

A Phase 1/2 Trial of Brief Androgen Suppression and Stereotactic Radiation Therapy (FASTR) for High-Risk Prostate Cancer

Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer

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