RESUMEN
PURPOSE: To compare the treatment outcomes of a cohort of prostate cancer patients treated with conventional schedule using IMRT or 3DRT technique. MATERIALS AND METHODS: Between 2010-2017, 485 men with localized prostate cancer were treated with conventional radiotherapy schedule with a total dose ≥74Gy using IMRT (231) or 3DCRT (254). Late gastrointestinal (GI) and genitourinary (GU) toxicity were retrospectively evaluated according to modifi ed RTOG criteria. The biochemical control was defi ned by the Phoenix criteria (nadir + 2ng/mL). The comparison between the groups included biochemical recurrence free survival (bRFS), overall survival (OS) and late toxicity. RESULTS: With a median follow-up of 51 months (IMRT=49 and 3DRT=51 months), the maximal late GU for ≥ grade- 2 during the entire period of follow-up was 13.1% in the IMRT and 15.4% in the 3DRT (p=0.85). The maximal late GI ≥ grade- 2 in the IMRT was 10% and in the 3DRT 24% (p=0.0001). The 5-year bRFS for all risk groups with IMRT and 3D-CRT was 87.5% vs. 87.2% (p=0.415). Considering the risk-groups no signifi cant difference for low-, intermediate- and high-risk groups between IMRT (low-95.3%, intermediate-86.2% and high-73%) and 3D-CRT (low-96.4%, intermediate-88.2% and high-76.6%, p=0.448) was observed. No signifi cant differences for OS and DMFS were observed comparing treatment groups. CONCLUSION: IMRT reduces signifi cantly the risk of late GI severe complication compared with 3D-CRT using conventional fractionation with a total dose ≥74Gy without any differences for bRFS and OS.
Asunto(s)
Neoplasias de la Próstata/radioterapia , Radioterapia Conformacional/métodos , Radioterapia de Intensidad Modulada/métodos , Anciano , Supervivencia sin Enfermedad , Relación Dosis-Respuesta en la Radiación , Tracto Gastrointestinal/efectos de la radiación , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Traumatismos por Radiación , Dosificación Radioterapéutica , Radioterapia Conformacional/efectos adversos , Radioterapia de Intensidad Modulada/efectos adversos , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Sistema Urogenital/efectos de la radiaciónRESUMEN
ABSTRACT Purpose: To compare the treatment outcomes of a cohort of prostate cancer patients treated with conventional schedule using IMRT or 3DRT technique. Materials and Methods: Between 2010-2017, 485 men with localized prostate cancer were treated with conventional radiotherapy schedule with a total dose ≥74Gy using IMRT (231) or 3DCRT (254). Late gastrointestinal (GI) and genitourinary (GU) toxicity were retrospectively evaluated according to modified RTOG criteria. The biochemical control was defined by the Phoenix criteria (nadir + 2ng/mL). The comparison between the groups included biochemical recurrence free survival (bRFS), overall survival (OS) and late toxicity. Results: With a median follow-up of 51 months (IMRT=49 and 3DRT=51 months), the maximal late GU for >=grade- 2 during the entire period of follow-up was 13.1% in the IMRT and 15.4% in the 3DRT (p=0.85). The maximal late GI ≥ grade- 2 in the IMRT was 10% and in the 3DRT 24% (p=0.0001). The 5-year bRFS for all risk groups with IMRT and 3D-CRT was 87.5% vs. 87.2% (p=0.415). Considering the risk-groups no significant difference for low-, intermediate- and high-risk groups between IMRT (low-95.3%, intermediate-86.2% and high-73%) and 3D-CRT (low-96.4%, intermediate-88.2% and high-76.6%, p=0.448) was observed. No significant differences for OS and DMFS were observed comparing treatment groups. Conclusion: IMRT reduces significantly the risk of late GI severe complication compared with 3D-CRT using conventional fractionation with a total dose ≥74Gy without any differences for bRFS and OS.
Asunto(s)
Humanos , Masculino , Anciano , Neoplasias de la Próstata/radioterapia , Radioterapia Conformacional/métodos , Radioterapia de Intensidad Modulada/métodos , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Traumatismos por Radiación , Dosificación Radioterapéutica , Factores de Tiempo , Sistema Urogenital/efectos de la radiación , Estudios Retrospectivos , Factores de Riesgo , Medición de Riesgo , Supervivencia sin Enfermedad , Radioterapia Conformacional/efectos adversos , Tracto Gastrointestinal/efectos de la radiación , Relación Dosis-Respuesta en la Radiación , Radioterapia de Intensidad Modulada/efectos adversos , Estimación de Kaplan-Meier , Clasificación del Tumor , Persona de Mediana EdadRESUMEN
SUMMARY BACKGROUND: A cost-effectiveness analysis of IMRT compared to 3D-CRT for head and neck cancer patients (HNCPs) was conducted in the Brazilian Public Health System. METHODS: A Markov model was used to simulate radiation therapy-induced dysphagia and xerostomia in HNCPs. Data from the PARSPORT trial and the quality-of-life study were used as parameters. The incremental cost-effectiveness ratio (ICER) and cost per quality-adjusted life-year (QALY) gained were calculated. RESULTS: At 2 years, IMRT was associated with an incremental benefit of 0.16 QALYs gained per person, resulting in an ICER of BRL 31,579 per QALY gained. IMRT was considered cost-effective when using the guideline proposed by the World Health Organization (WHO) of three times the national gross domestic product (GDP) per capita (BRL 72,195). Regarding life expectancy (15 years), the incremental benefit of IMRT was 1.16 QALYs gained per person, with an ICER of BRL 4,341. IMRT was also cost-effective using the WHO definition, which states that the maximum cost is equal to the GDP per capita (BRL 24,065). CONCLUSIONS: IMRT was considered cost-effective from the perspective of the Brazilian public health system.
RESUMO INTRODUÇÃO: Foi realizada uma análise de custo-efetividade da radioterapia com intensidade modulada de feixe (IMRT) comparada com a radioterapia conformada para pacientes com câncer de cabeça e pescoço (CCP) no contexto do Sistema Único de Saúde (SUS). MÉTODOS: Foi elaborado um modelo de Markov para comparar os custos médicos diretos e os desfechos de saúde relacionados à qualidade de vida do paciente pós-intervenção radioterápica sofrendo de xerostomia e disfagia. Com essa finalidade, foram usados os dados do estudo PARSPORT e parâmetros de qualidade de vida. Os resultados comparativos das estratégias alternativas de tratamento foram medidos pela razão de custo-efetividade incremental (RCEI). O desfecho analisado foi o de anos de vida ajustados à qualidade (QALY). RESULTADOS: Em um horizonte de tempo de dois anos, a IMRT foi associada com um benefício incremental de ganho de 0,16 QALYs por indivíduo, resultando em um RCEI de R$ 31.579 por QALY ganhado. A IMRT foi custo-efetivo, adotando-se o limite máximo de disposição a pagar, proposto pela OMS, de três vezes o PIB per capita nacional, equivalente a R$ 72.195. No horizonte de tempo de 15 anos, o benefício incremental de ganho foi de 1,16 QALYs por indivíduo, com um RCEI de R$ 4.341. A IMRT foi custo-efetivo, adotando-se o limite de disposição a pagar, proposto pela OMS, de uma vez o PIB per capita nacional, equivalente a R$ 24.065. CONCLUSÃO: A IMRT foi considerada um tratamento custo-efetivo na perspectiva do SUS.