Intensity modulated radiotherapy (IMRT) for prostate cancer

PICHON RIVIERE, A.; AUGUSTOVSKI, F.; GARCIA MARTI, S.; GLUJOVSKY, D.; LOPEZ, A; ALCARAZ, A.; BARDACH, A.; CIAPPONI, A; MEZA, V

Evaluación de Tecnologías Sanitarias

IECS

Año: 2013 p. 1 - 30

1668-2793

In Argentina, prostate cancer (PC) is the second cause of death cancer in men. External radiation therapy (RT) may be used in all the disease stages. At present, the most commonly used technique is 3D-conformal radiation therapy (3D-CRT). IMRT is proposed as a therapeutic alternative that might have the potential to administer high doses with less adverse events. Technology IMRT is a form of 3D-CRT which through planning and a multileaf collimator allows to modulate the number and doses of radiation beams. This enables to irradiate the tumor with higher doses minimizing the radiation received by the surrounding organs. Purpose To assess the available evidence on the efficacy, safety and coverage policy related aspects regarding the use of IMRT in patients with prostate cancer. Methods A bibliographic search was carried out on the main databases: DARE, NHS EED, on Internet general search engines, in health technology evaluation agencies and health sponsors. Priority was given to the inclusion of systematic reviews (SR); controlled randomized clinical trials (RCTs); health technology assessments and economic evaluations, clinical practice guidelines (CPG), coverage policies of other health systems and case series reports with mortality and/or disease-free survival results. Results This report includes five SRs, three non-randomized controlled studies, two case series reports, four economic evaluations, three health technology assessments, eight CPGs and information on coverage from health sponsors. All the studies found assessed patients with localized or locally advanced PC; no studies assessing this technique as adjuvant or rescue radiation therapy or in patients with bone metastases have been found. One SR from 2010 included eight studies which compared case series of IMRT with 3D-CRT; no RCT has been identified. The quality of the included studies is poor. None of the studies reported differences in terms of overall or disease-free survival in both techniques. Two studies did not find differences in biochemical relapse free survival (BRFS), while another one found a longer BRFS with IMRT (72.6,6% vs. 50.1%,p