Intensity-Modulated Radiation Therapy for Prostate Cancer
Thanks to advances in medical technology, the options available for men with prostate cancer are now more plentiful than ever. Different approaches can be taken depending on the type of cancer, the speed at which it is spreading and preference of the doctor, all with the patient's individual situation being taken into consideration.
Today, let's take a look at intensity-modulated radiation therapy (IMRT).
IMRT was developed in the late 1990s to deliver radiation more precisely to a prostate cancer tumor, sparing a significant amount of the surrounding non-cancerous tissue. According to a report in Oncology, IMRT uses computer-controlled radiation deposition to contrast cancerous tissue with normal tissue, as opposed to the more traditional trial-and-error approach. IMRT can treat multiple targets simultaneously at different intensities of radiation, which dramatically increases precision. IMRT also utilizes a SMART (simultaneous modulated accelerated radiation therapy) boost, which cuts the overall treatment time.
In a 2002 study in the International Journal of Radiation Oncology, Biology and Physics, IMRT was tested with several hundred patients and proved to be the most effective treatment option, with reduced rectal toxicity and improved short-term PSA levels. The report concluded that, based on the risk-benefit analysis, IMRT would become the standard mode of treatment for localized prostate cancer.
Later studies have found IMRT to have both pros and cons among patients with non-metastatic prostate cancer. In a report in JAMA, patients experienced less gastrointestinal problems and fewer hip fractures, but had more erectile dysfunction following treatment.
A 2012 study from Wayne State University found IMRT to be very effective in protecting non-cancerous tissue compared with older techniques, and results have translated across race and socioeconomic lines, and also disease risk classification. However, the study does note that IMRT is more expensive than older treatments, but it concluded that it is still a cost-effective solution.
Despite the positive feedback about IMRT, there has been a negative development. Cases in California, Washington, Maryland and South Carolina have reflected that some doctors may be performing this procedure as a means to procure the maximum financial payments from Medicare. According to a statement by Dr. Matthew Cooperberg of the University of California, San Francisco, "IMRT is overused, period," noting that some doctors propose the $37,000 procedure when a $2,000 procedure may be sufficient. He noted that 50,000 men receive the treatment each year, but says that half of them do not need it or "don't gain anything from it that exceeds cheaper treatment," as quoted by Bloomberg News. Cooperberg estimates that the overuse of this treatment has resulted in $1 billion in unnecessary overspending.
So while IMRT has been shown to be a very effective treatment for prostate cancer, patients who have questions about it as an option should not hesitate to talk to their doctor to determine the best course of action.
Amin, N, Konski, AA. (August 2012). "Intensity-modulated radiation therapy for prostate cancer is cost effective and improves therapeutic ratio." Expert Review of Pharmacoeconomics and Outcomes Research. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22971031.
Sheets, NC., et al. (18 April 2012). "Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer." Journal of the American Medical Association. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22511689.
Teh, BS, Woo, SY, Butler, EB. (1999). "Intensity modulated radiation therapy (IMRT): a new promising technology in radiation oncology." Oncology 4(6):433-432. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10631687.
Zelefsky, MJ, et al. (1 August 2002). "High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients." International Journal of Radiation Oncology, Biology and Physics. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12128109.