Comparative Effectiveness Studies Explore Cancer, Trauma Care

Cheryl Clark, for HealthLeaders Media , April 18, 2012

Prostate Cancer and Proton Beam Therapy
The third, and perhaps most controversial, paper focused on a comparison of three types of treatments for non-metastatic prostate cancer in Medicare beneficiaries and found no additional benefit despite the proliferation of construction of expensive proton beam centers across the country.

The paper compared older conformal radiation therapy, the newer and more common intensity-modulated radiation therapy (IMRT), with proton beam.

Ronald Chen, MD, of the University of North Carolina at Chapel Hill said that based on outcomes in 12,976 men treated between 2000 and 2008, IMRT resulted in fewer gastrointestinal co-morbidities and hip fractures, but was more likely to result in erectile dysfunction compared with older conformal radiation therapy.

Comparing proton beam radiation just with IMRT revealed fewer gastrointestinal complications with IMRT, and no significant differences in rates of other morbidities or additional therapies between the two treatments.

Chen said the researchers looked at side effects such as bowel obstructions, rectal bleeding, urinary incontinence, all of which have been associated with various forms of radiation therapy for prostate cancer.

He added that proton beam centers, which cost an estimated $400 million each and require new structures, have moved forward in recent years based on their theoretical benefits that they may be able to reduce damage to surrounding organs because the beams may be more accurately targeted.

Two additional studies, one at Massachusetts General Hospital and the other at UNC, are looking at quality of life issues for various treatment options. "Hopefully these two studies will allow patients to answer these important questions," he said.

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