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Proton RT for Prostate Cancer Has Reduced Toxicity, Higher Cost vs Other RT Options – Modern Medicine Network

by Dave Levitan, Prostate Cancer, Genitourinary Cancers
First published Mar 26, 2018
View original article here

Proton radiation therapy offers some reduced toxicity over intensity-modulated radiotherapy (IMRT) in patients under the age of 65 with prostate cancer, but its cost is nearly twice that of IMRT, according to a new analysis. Stereotactic body radiotherapy (SBRT) had a slightly lower cost than IMRT, with a similar toxicity profile. 

IMRT became the most common treatment for localized prostate cancer between 2000 and 2010, and newer radiation techniques have sought to improve on IMRT. “Proton therapy decreases low-dose radiation exposure to uninvolved organs, which potentially translates into lower risks of treatment toxicity and second malignancy,” wrote study authors led by Benjamin D. Smith, MD, of the University of Texas MD Anderson Cancer Center in Houston. “Alternatively, SBRT decreases the number of treatment fractions to only five or fewer, thereby improving convenience and lowering cost.”

Some evidence has suggested that proton radiation costs more, with little added benefit, while SBRT can lower costs while potentially increasing toxicity. Most of that evidence, however, is in older men, though more than 40% of prostate cancer diagnoses occur in those under 65 years. The new study compared the three radiation treatments in a cohort of younger men using a private insurance claims database. The results were published in the Journal of Clinical Oncology.

A total of 693 patients received proton radiation between 2008 and 2015; these were matched to 3,465 IMRT patients. The proton therapy patients had a lower risk of composite urinary toxicity at 2 years, at a rate of 33% compared with 42% (P < .001); this persisted on sensitivity analyses that distinguished between early, late, or procedure-only toxicity. Erectile dysfunction was also less likely with proton therapy, at a rate of 21% at 2 years compared with 28% (P < .001). Bowel toxicity was higher with proton therapy, however, at 20% at 2 years compared with 15% with IMRT (P = .02).

The mean radiation cost was $115,501 with proton therapy, compared with $59,012 with IMRT (P < .001); the cost to the patient with each therapy was $2,269 and $1,714, respectively (P < .001). The 2-year mean complication cost was lower with proton therapy ($1,737 vs $2,730; P = .008), but the mean total healthcare cost was higher ($133,220 vs $79,209; P < .001).

In a comparison between 310 SBRT patients and 3,100 matched IMRT patients, there were no differences in composite urinary, bowel, or erectile dysfunction toxicity rates at 2 years. The mean cost for SBRT was $49,504, compared with $57,244 for IMRT (P < .001); the cost to the patient was $1,015 and $1,560, respectively (P < .001). The mean complication costs and total healthcare costs were similar at 2 years.

“These key findings, coupled with the real-world private insurance cost reported herein, will be useful for patients selecting the most appropriate treatment and for researchers designing cost-effectiveness models to guide treatment decisions in prostate cancer,” the researchers concluded.

Dosimetric comparison to the heart and cardiac substructure in a large cohort of esophageal cancer patients treated with proton beam therapy or Intensity-modulated radiation therapy

Dosimetric comparison to the heart and cardiac substructure in a large cohort of esophageal cancer patients treated with proton beam therapy or Intensity-modulated radiation therapy.

Author information  Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States; Department of Radiology, Keio University School of Medicine, Tokyo, Japan.



To compare heart and cardiac substructure radiation exposure using intensity-modulated radiotherapy (IMRT) vs. proton beam therapy (PBT) for patients with mid- to distal esophageal cancer who received chemoradiation therapy.


We identified 727 esophageal cancer patients who received IMRT (n=477) or PBT (n=250) from March 2004 to December 2015. All patients were treated to 50.4Gy with IMRT or to 50.4 cobalt Gray equivalents with PBT. IMRT and PBT dose-volume histograms (DVHs) of the whole heart, atria, ventricles, and four coronary arteries were compared. For PBT patients, passive scattering proton therapy (PSPT; n=237) and intensity-modulated proton therapy (IMPT; n=13) DVHs were compared.


Compared with IMRT, PBT resulted in significantly lower mean heart dose (MHD) and heart V5, V10, V20, V30, and V40as well as lower radiation exposure to the four chambers and four coronary arteries. Compared with PSPT, IMPT resulted in significantly lower heart V20, V30, and V40 but not MHD or heart V5 or V10. IMPT also resulted in significantly lower radiation doses to the left atrium, right atrium, left main coronary artery, and left circumflex artery, but not the left ventricle, right ventricle, left anterior descending artery, or right coronary artery. Factors associated with lower MHD included PBT (P<0.001), smaller planning target volume (PTV; P<0.001), and gastroesophageal junction (GEJ) tumor (P<0.001). Among PBT patients, factors associated with lower MHD included IMPT (P=0.038), beam arrangement other than AP/PA (P<0.001), smaller PTV (P<0.001), and GEJ tumor (P<0.001).


In patients with mid- to distal esophageal cancer, PBT results in significantly lower radiation exposure to the whole heart and cardiac substructures than IMRT. Long-term studies are necessary to determine how this cardiac sparing effect impacts the development of coronary artery disease and other cardiac complications.

Original article here

Feedback PLC – Collaboration with the University of Texas MD Anderson Cancer Center, Houston, Texas, USA

FBKlogoFeedback plc (FDBK), the medical imaging software company, is pleased to announce that it has signed a research agreement with The University of Texas MD Anderson Cancer Center in Houston, Texas, USA, to investigate the potential future clinical application of Feedback’s TexRAD texture analysis software on computed tomography (CT) image data of patients with kidney and adrenal cancer. This will be a retrospective study and the results will not be used to influence or guide the treatment regime for existing patients.

The research collaboration will be led by Prof. Haesun Choi (Professor, Department of Diagnostic Radiology, MD Anderson Cancer Center). Prof. Choi is a world leading imaging expert and is renowned for developing the CT based “Choi criteria” for assessing response to anti-vascular therapy extensively used around the world in clinical, research and pharmaceutical drug trials.

Prof. Haesun Choi commented: “Limitations of the size-based traditional response evaluation criteria in solid tumor have been well recognized, particularly, in those treated with the new molecularly targeted agents. More reliable user-friendly biomarkers that can reflect the tumor response and that can be used in risk-stratification are needed. The tumors are known to be heterogeneous in their phenotypes and genotypes. Analyzing the tumor heterogeneity on CT images may provide insights of tumors that may be useful in evaluating the tumor response. MD Anderson Cancer Center currently is exploring of the potential value of this new mean in kidney cancers.”

Dr. Balaji Ganeshan, Chief Scientist & New Business Officer of the Company’s subsidiaries TexRAD Ltd & Cambridge Computed Imaging Ltd commented: “Prof. Haesun Choi is one of the top and highly recognized imaging experts based at the very prestigious MD Anderson Cancer Center. For the last 25 years MD Anderson Cancer Center has consistently ranked as one of the USA’s top two cancer centres receiving over 120,000 people last year for care, services and clinical trial. We are delighted that she will be leading the large comprehensive patient population study (around 400 patients with kidney and adrenal cancers) on CT to strengthen the evidence base of TexRAD as the leading tumour texture heterogeneity analysis software. The investigation in kidney and adrenal cancer patient risk-stratification and treatment response evaluation, will potentially lead to the established use of TexRAD in pharmaceutical drug trials and clinical management. Working with MD Anderson Cancer Center will significantly enhance our TexRAD research collaborator base and credibility with the addition of this key site in the USA.”

For further information contact:

Feedback plc
Tel: 01954 718072
Simon Barrell / Trevor Brown / Tom Charlton

Sanlam Securities UK (Nominated Adviser and Joint Broker)
Tel: 020 7628 2200
Simon Clements / Virginia Bull

Peterhouse Corporate Finance Ltd (Joint Broker)
Tel: 020 7469 0936
Lucy Williams / Duncan Vasey

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