Arunan Sujenthiran1, Julie Nossiter2, Susan C Charman3, Matthew Parry3, Prokar Dasgupta4, Jan van der Meulen5, Paul J Cathcart6, Noel W Clarke7, Heather Payne8, Ajay Aggarwal9. 1. Clinical Effectiveness Unit, Royal College of Surgeon of England, London, United Kingdom. Electronic address: asujenthiran@doctors.org.uk. 2. Clinical Effectiveness Unit, Royal College of Surgeon of England, London, United Kingdom. 3. Clinical Effectiveness Unit, Royal College of Surgeon of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom. 4. Medical Research Council Centre for Transplantation, National Institute for Health Research Biomedical Research Centre, King's College London, London, United Kingdom. 5. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom. 6. Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. 7. Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, London, United Kingdom. 8. Department of Oncology, University College London Hospitals, London, United Kingdom. 9. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Abstract
PURPOSE: To compare, in a national population-based study, severe genitourinary (GU) and gastrointestinal (GI) toxicity in patients with prostate cancer who were treated with radical intensity modulated radiation therapy (IMRT) or 3-dimensional conformal radiation therapy (3D-CRT). METHODS AND MATERIALS: Patients treated with IMRT (n=6933) or 3D-CRT (n=16,289) between January 1, 2010 and December 31, 2013 in the English National Health Service were identified using cancer registry data, the National Radiotherapy Dataset, and Hospital Episodes Statistics, the administrative database of care episodes in National Health Service hospitals. We developed a coding system that identifies severe toxicity (at least grade 3 according to the National Cancer Institute Common Terminology Criteria for Adverse Events scoring system) according to the presence of a procedure and a corresponding diagnostic code in patients' Hospital Episodes Statistics records after radiation therapy. A competing risks regression analysis was used to estimate hazard ratios (HRs), comparing the incidence of severe GI and GU complications after IMRT and 3D-CRT, adjusting for patient, disease, and treatment characteristics. RESULTS: The use of IMRT, as opposed to 3D-CRT, increased from 3.1% in 2010 to 64.7% in 2013. Patients who received IMRT were less likely than those receiving 3D-CRT to experience severe GI toxicity (4.9 vs 6.5 per 100 person-years; adjusted HR 0.66; 95% confidence interval 0.61-0.72) but had similar levels of GU toxicity (2.3 vs 2.4 per 100 person-years; adjusted HR 0.94; 95% confidence interval 0.84-1.06). CONCLUSIONS: Prostate cancer patients who received radical radiation therapy using IMRT were less likely to experience severe GI toxicity, and they had similar GU toxicity compared with those who received 3D-CRT. These findings in an unselected "real-world" population support the use of IMRT, but further cost-effectiveness studies are urgently required.
PURPOSE: To compare, in a national population-based study, severe genitourinary (GU) and gastrointestinal (GI) toxicity in patients with prostate cancer who were treated with radical intensity modulated radiation therapy (IMRT) or 3-dimensional conformal radiation therapy (3D-CRT). METHODS AND MATERIALS: Patients treated with IMRT (n=6933) or 3D-CRT (n=16,289) between January 1, 2010 and December 31, 2013 in the English National Health Service were identified using cancer registry data, the National Radiotherapy Dataset, and Hospital Episodes Statistics, the administrative database of care episodes in National Health Service hospitals. We developed a coding system that identifies severe toxicity (at least grade 3 according to the National Cancer Institute Common Terminology Criteria for Adverse Events scoring system) according to the presence of a procedure and a corresponding diagnostic code in patients' Hospital Episodes Statistics records after radiation therapy. A competing risks regression analysis was used to estimate hazard ratios (HRs), comparing the incidence of severe GI and GU complications after IMRT and 3D-CRT, adjusting for patient, disease, and treatment characteristics. RESULTS: The use of IMRT, as opposed to 3D-CRT, increased from 3.1% in 2010 to 64.7% in 2013. Patients who received IMRT were less likely than those receiving 3D-CRT to experience severe GI toxicity (4.9 vs 6.5 per 100 person-years; adjusted HR 0.66; 95% confidence interval 0.61-0.72) but had similar levels of GU toxicity (2.3 vs 2.4 per 100 person-years; adjusted HR 0.94; 95% confidence interval 0.84-1.06). CONCLUSIONS:Prostate cancerpatients who received radical radiation therapy using IMRT were less likely to experience severe GI toxicity, and they had similar GU toxicity compared with those who received 3D-CRT. These findings in an unselected "real-world" population support the use of IMRT, but further cost-effectiveness studies are urgently required.
Authors: Matthew G Parry; Arunan Sujenthiran; Thomas E Cowling; Julie Nossiter; Paul Cathcart; Noel W Clarke; Heather Payne; Jan van der Meulen; Ajay Aggarwal Journal: J Clin Oncol Date: 2019-06-04 Impact factor: 44.544
Authors: Tanja Sprave; Vivek Verma; Robert Förster; Ingmar Schlampp; Thomas Bruckner; Tilman Bostel; Stefan Ezechiel Welte; Eric Tonndorf-Martini; Rami El Shafie; Nils Henrik Nicolay; Jürgen Debus; Harald Rief Journal: Strahlenther Onkol Date: 2018-07-05 Impact factor: 3.621
Authors: B A Jereczek-Fossa; A Maucieri; G Marvaso; S Gandini; C Fodor; D Zerini; G Riva; O Alessandro; A Surgo; S Volpe; G Fanetti; S Arculeo; M A Zerella; S Parisi; P Maisonneuve; A Vavassori; F Cattani; R Cambria; C Garibaldi; A Starzyńska; G Musi; O De Cobelli; M Ferro; F Nolè; D Ciardo; R Orecchia Journal: Med Oncol Date: 2018-11-27 Impact factor: 3.064
Authors: Julie Nossiter; Arunan Sujenthiran; Thomas E Cowling; Matthew G Parry; Susan C Charman; Paul Cathcart; Noel W Clarke; Heather Payne; Jan van der Meulen; Ajay Aggarwal Journal: J Clin Oncol Date: 2020-01-02 Impact factor: 44.544