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Comparative Study
. 2011 Nov 15;81(4):e325-34.
doi: 10.1016/j.ijrobp.2011.02.006. Epub 2011 Apr 16.

Outcomes after intensity-modulated versus conformal radiotherapy in older men with nonmetastatic prostate cancer

Justin E Bekelman  1 , Nandita Mitra, Jason Efstathiou, Kaijun Liao, Robert Sunderland, Deborah N Yeboa, Katrina Armstrong
Affiliations
Comparative Study

Outcomes after intensity-modulated versus conformal radiotherapy in older men with nonmetastatic prostate cancer

Justin E Bekelman et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: There is little evidence comparing complications after intensity-modulated (IMRT) vs. three-dimensional conformal radiotherapy (CRT) for prostate cancer. The study objective was to test the hypothesis that IMRT, compared with CRT, is associated with a reduction in bowel, urinary, and erectile complications in elderly men with nonmetastatic prostate cancer.

Methods and materials: We undertook an observational cohort study using registry and administrative claims data from the SEER-Medicare database. We identified men aged 65 years or older diagnosed with nonmetastatic prostate cancer in the United States between 2002 and 2004 who received IMRT (n = 5,845) or CRT (n = 6,753). The primary outcome was a composite measure of bowel complications. Secondary outcomes were composite measures of urinary and erectile complications. We also examined specific subsets of bowel (proctitis/hemorrhage) and urinary (cystitis/hematuria) events within the composite complication measures.

Results: IMRT was associated with reductions in composite bowel complications (24-month cumulative incidence 18.8% vs. 22.5%; hazard ratio [HR] 0.86; 95% confidence interval [CI], 0.79-0.93) and proctitis/hemorrhage (HR 0.78; 95% CI, 0.64-0.95). IMRT was not associated with rates of composite urinary complications (HR 0.93; 95% CI, 0.83-1.04) or cystitis/hematuria (HR 0.94; 95% CI, 0.83-1.07). The incidence of erectile complications involving invasive procedures was low and did not differ significantly between groups, although IMRT was associated with an increase in new diagnoses of impotence (HR 1.27, 95% CI, 1.14-1.42).

Conclusion: IMRT is associated with a small reduction in composite bowel complications and proctitis/hemorrhage compared with CRT in elderly men with nonmetastatic prostate cancer.

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Conflict of interest statement

Conflicts of interest: Dr. Bekelman reports serving as a consultant for the Riverside Company and receiving grants to his institution from the American Cancer Society and philanthropic sources. Dr. Armstrong reports receiving grants to her institution from the National Institutes of Health, the Department of Defense, the American Cancer Society, and the RobertWood Johnson Foundation. All other authors report no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
(a) Cumulative incidence of composite bowel complications requiring an invasive procedure after intensitymodulated (IMRT) and three-dimensional conformal (CRT) radiotherapy. (b) Cumulative incidence of composite urinary complications requiring invasive procedures after IMRT and CRT. (c). Cumulative incidence of subsets of bowel and urinary complications requiring invasive procedures after IMRT and CRT
See this image and copyright information in PMC

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