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Proton therapy treatment room
(Courtesy of Varian Medical Systems).

Proton therapy did not improve treatment-related toxicity in prostate cancer, study finds

by Nancy Ryerson , Staff Writer
Proton radiotherapy (PRT), an expensive cancer treatment that has received much buzz, did not show any less treatment-related toxicity for prostate cancer patients between 0 and 12 months than less costly intensity-modulated radiotherapy (IMRT), according to a new study published in the Journal of the National Cancer Institute.

The study looked at Medicare beneficiaries age 66 or older who received PRT or IMRT for prostate cancer between 2008 and 2009. Each PRT patient was matched with an IMRT patient with similar clinical and socioeconomic backgrounds. While PRT showed a reduction in genitourinary toxicity in the first six months, when measuring toxicity out to 12 months that difference disappeared.

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"IMRT is the standard of care for prostate cancer, and it already has an outstanding side effect profile," study author James Yu told DOTmed News. "And so we were curious as to whether this more resource intensive and more extensive therapy was better than an already excellent treatment."

According to the study, Median Medicare reimbursement was $32,428 for PRT and $18,575 for IMRT.

Proton therapy has received attention because studies have suggested it causes fewer side effects than traditional radiation. Protons deposit a low dose of radiation when they enter the body, releasing most of it at the end of their path. In theory, that allows oncologists to direct radiation treatment more precisely and reduce damage to tissue surrounding a tumor.

The therapy has been found to improve late side effects in some pediatric brain cancers, but few long-term studies have been performed on other cancers.

"I think the problem with treating the prostate is that you have to add a margin of error because you can't position the patient in the same position every treatment," said Yu. "Also, the rectum is immediately adjacent to the prostate, and the urethra travels right through the prostate, so you can't really avoid those even if you have perfect dosimetry."

There are currently 11 proton therapy centers in the United States. The University of Florida Proton Therapy Institute, which recently installed technology that tracks tumors as they move, responded to Yu's study with data it collected after five years of providing treatment. The Institute says proton therapy resulted in minimal bowel and urinary side effects as well as 99 percent survival in low and intermediate cases, and 74 percent survival in high-risk prostate cancer patients.

Still, Yu as well as organizations such as the National Cancer Institute, Institute of Medicine and the Agency for Healthcare Research and Quality have called for more randomized studies to measure the value of the treatment before more facilities call for it in prostate cancer.

"I think proton therapy is an important part of our treatment as radiation oncologists but the emphasis on prostate cancer treatment may be misplaced," said Yu.


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Dennis Valencia

Blind Leading the Blind!!

January 02, 2013 10:52

It is a terrible injustice how one group of potentially biased researchers can publish findings on a therapy that they are not even proficient at by selecting to focus on a fraction of one single measurement parameter and then reporting it out like it is meaningful, or even worse, like it is the ultimate verification of the efficacy of that modality. Worse than that the potentially biased media picks up the press-release of study then publishes it without any further research; while often making up their own biased head-lines in order to strike another unfair blow against a modality that they too have a minimal understanding of. If somebody wants to do a fair comparison of protons versus photons; they would be best served by bringing out the entire therapeutic picture, which includes but is not limited to; dose-escalation, dose-response, control rates, immobilization techniques, control rates, toxicity and survival. Quality of life measurements should go beyond a year; reporting on anything less seems highly suspicious.

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Wayne Webster

Blind Leading the Blind from Dennis Valencia

January 02, 2013 03:25

Mr. Valencia, I think your attack on this one article is unfortunate. I believe the facts are quite clear when speaking to centers about how they make their decisions as to which imaging modalities, surgical applications and in this case radiation therapy offerings frequently they decide on early science and high reimbursement.

Proton Therapy is interesting but like most new technologies it really isn't clear that it is much better than anything else. If you have statistics to prove Proton Therapy is so much better that it is worthy of reimbursement that is 2X or more than standard photon therapy then please publish them please.

I'm not against Proton Therapy and its installation in the US and elsewhere. But when you read the articles that support any new modality the authors are almost always twisting the statistics to demonstrate how what they do is better than what is already done. I think we have to think about the entire population and determine if there is enough of an improvement to justify the cost. If we don't start thinking this way for ourselves then maybe the payers will take it upon themselves to do it for us.

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Wayne Webster

Misplaced attention on Prostate Cancer

January 02, 2013 10:52

I agree with Dr. Yu as to our focus on small improvements with PRT as compared to IMRT. Not unlike Neutron therapy of the 1980s we are focused on a cancer that is already treated reasonably well with IMRT.

Protons have some very interesting characteristics and should be studied and examined carefully. These centers are not inexpensive and if we do not try our best to justify their existence and use at these high reimbursement levels they will be some of the first big cuts when Obamacare is fully enacted. We either police ourselves or the Government will do it for us. These centers could be easily dealt a death blow with legislation as far sweeping as the Stark Law.

Let's face it when you speak with someone planning a PRT center they speak of the potential improvements in care and in revenue production almost hand-in-hand. This is a recipe for disaster in a time when reimbursement and the quality/effectiveness of the clinical service will be closely scrutinized by non clinicians employed by the Government.

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