Comparative Toxicities and Cost of Intensity-Modulated Radiotherapy, Proton Radiation, and Stereotactic Body Radiotherapy Among Younger Men With Prostate Cancer

Abstract

Purpose To compare the toxicities and cost of proton radiation and stereotactic body radiotherapy (SBRT) with intensity-modulated radiotherapy (IMRT) for prostate cancer among men younger than 65 years of age with private insurance. Methods Using the MarketScan Commercial Claims and Encounters database, we identified men who received radiation for prostate cancer between 2008 and 2015. Patients undergoing proton therapy and SBRT were propensity score-matched to IMRT patients on the basis of clinical and sociodemographic factors. Proportional hazards models compared the cumulative incidence of urinary, bowel, and erectile dysfunction toxicities by treatment. Cost from a payer's perspective was calculated from claims and adjusted to 2015 dollars. Results A total of 693 proton therapy patients were matched to 3,465 IMRT patients. Proton therapy patients had a lower risk of composite urinary toxicity (33% v 42% at 2 years; P < .001) and erectile dysfunction (21% v 28% at 2 years; P < .001), but a higher risk of bowel toxicity (20% v 15% at 2 years; P = .02). Mean radiation cost was $115,501 for proton therapy patients and $59,012 for IMRT patients ( P < .001). A total of 310 SBRT patients were matched to 3,100 IMRT patients. There were no significant differences in composite urinary, bowel, or erectile dysfunction toxicities between SBRT and IMRT patients ( P > .05), although a higher risk of urinary fistula was noted with SBRT (1% v 0.1% at 2 years; P = .009). Mean radiation cost for SBRT was $49,504 and $57,244 for IMRT ( P < .001). Conclusion Among younger men with prostate cancer, proton radiation was associated with significant reductions in urinary toxicity but increased bowel toxicity at nearly twice the cost of IMRT. SBRT and IMRT were associated with similar toxicity profiles; SBRT was modestly less expensive than IMRT.

The collaborative management of late urological complications after radiation therapy

“…As late effects of radiotherapy occur over many years and radiotherapy is used frequently for pelvic malignancies, including the most common male cancer (prostate cancer), the denominator is likely to be large.Highlighting information on the fistula rates was also potentially misleading, given a previous analysis and audit of prostate radiotherapy at the Austin Uro-Oncology department [3]. This showed a low toxicity profile and a low fistula rate among patients that was consistent with the published literature, which is 0.1% [4], not dissimilar to the reported 30-day mortality rate after prostatectomy [5] and similar to the severe urinary stricture rate after external beam radiotherapy alone.These severe complication figures would be more useful and more lessons would be learned if their occurrence were examined in light of the concomitant surgical procedures or endoscopic interventions [6]. Severe late radiation complications are more common when external beam radiotherapy is associated with prostatectomy and brachytherapy.…”

“…Highlighting information on the fistula rates was also potentially misleading, given a previous analysis and audit of prostate radiotherapy at the Austin Uro-Oncology department [3]. This showed a low toxicity profile and a low fistula rate among patients that was consistent with the published literature, which is 0.1% [4], not dissimilar to the reported 30-day mortality rate after prostatectomy [5] and similar to the severe urinary stricture rate after external beam radiotherapy alone.…”

Proton Beam Therapy for Prostate Cancer: An Overview

“…It was found that among younger men with prostate cancer, proton radiation was associated with significant reductions in urinary toxicity but increased bowel toxicity at nearly twice the cost of IMRT. 10 Iwata H and coworkers conducted a multi-institutional retrospective survey of the long-term outcomes of PBT for prostate cancer in Japan. There were 215, 520, and 556 patients in the low-risk, intermediate-risk, and high-risk groups, respectively.…”

Comparative toxicity outcomes of proton‐beam therapy versus intensity‐modulated radiotherapy for prostate cancer in the postoperative setting

“…5 Mainly retrospective reports exist in the intact setting, reporting small advantages to PBT with respect to genitourinary (GU) and gastrointestinal (GI) toxicity; however, these studies are limited Cancer December 1, 2019 by confounding and misclassification bias. 6,7 One casematched analysis demonstrated that, when compared to IMRT, definitive treatment of PC with PBT was not associated with significant differences in acute or late GU/GI toxicities-although a shorter median follow-up of 29 months post-PBT limited the assessment of long-term toxicities. 8 Relative to the intact setting, literature on postprostatectomy PBT is sparse.…”