Is IMRT, SBRT, or Proton Radiation Least Costly, Toxic for Patients With Prostate Cancer?


A recent study compared the costs and toxicities of proton radiation, stereotactic body radiotherapy (SBRT), and intensity-modulated radiotherapy (IMRT) for younger patients with prostate cancer.

The study was published in the Journal of Clinical Oncology (online March 21, 2018; doi:10.1200/JCO.2017.75.5371).

SBRT may be a less expensive treatment option than IMRT for patients with prostate cancer. However, toxicity could be increased for patients receiving SBRT due to a greater biologic dose of radiation being delivered. Studies comparing the treatment costs and toxicities are needed.

A group of researchers from The University of Texas MD Anderson Cancer Center (Houston, TX), conducted a study to compare the toxicities of proton radiation, SBRT, and IMRT in patients aged younger than 65 years with prostate cancer and with private insurance. A total of 693 patients receiving proton therapy were propensity score matched (based on clinical and sociodemographic factors) with 3465 patients receiving IMRT, as well as 310 patients receiving SBRT matched with 3100 patients receiving IMRT. All patients were diagnosed with prostate cancer from 2008 through 2015.

Cumulative incidence of urinary, bowel, and erectile dysfunction toxicities by treatment were compared through proportional hazards models. Cost from the payer perspective was calculated from claims and adjusted to 2015 dollars.

Results of the analysis showed that patients receiving proton therapy had a lower risk of composite urinary toxicity (33% vs 42%; P .001) and erectile dysfunction (21% vs 28%; P  .001) at 2 years compared with those receiving IMRT. However, a higher risk of bowel toxicity was associated with proton therapy (20% vs 15% at 2 years, respectively; P = .02).

Researchers reported that the mean radiation cost was $115,501 for those receiving proton therapy and $59,012 for those receiving IMRT (P  .001).


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In the comparison between SBRT and IMRT, there were no observable differences in composite urinary, bowel, or erectile dysfunction toxicities (P .05), though a higher risk of urinary fistula was noted for those receiving SBRT (1% vs 0.1% at 2 years, respectively; P = .009).

The mean radiation cost for SBRT was $49,504 and $57,244 for IMRT (P  .001).

Researchers concluded that proton radiation is associated with decreased urinary toxicity but increased bowel toxicity at nearly twice the cost of IMRT for younger patients with prostate cancer. Furthermore, SBRT shows a similar toxicity profile to IMRT, though the former is moderately less expensive.—Zachary Bessette