IMRT for prostate cancer: newer, costlier radiation no better than old

HealthDay reports on a paper published in JAMA Internal Medicine:

“The costly form of radiation therapy that has become the norm for prostate cancer in the United States may be no better than the older, cheaper variety — at least for some men, a new study suggests.

Researchers found that among more than 1,000 U.S. men who had radiation therapy after prostate cancer surgery, the newer form — known as intensity-modulated radiotherapy (IMRT) — had no advantage over the conventional version.

Men who received IMRT were no less likely to be treated for a prostate cancer recurrence over the next few years. And their rates of long-term side effects — such as urinary incontinence and erectile dysfunction — were no lower.

But the findings, reported online May 20 in JAMA Internal Medicine, will not spell the doom of IMRT. One reason is, the vast majority of U.S. men who receive radiation for prostate cancer are already given IMRT.

“I don’t think this is going to change practice,” said Dr. Matthew Cooperberg, a urologist at the University of California, San Francisco, who wrote an editorial published with the study. (Publisher’s note:  I added the hyperlink to the editorial.  I don’t know why HealthDay didn’t.  They should.) 

But he said the findings do beg the question of why IMRT is reimbursed at such a high rate. A 2011 study in the Journal of Clinical Oncology found that Medicare paid out an average of nearly $11,000 more for IMRT, versus the older radiation therapy (called conformal radiotherapy).

“We need a reimbursement system that rewards outcomes instead of technology,” Cooperberg said.

…

IMRT has exploded in the United States in the last decade or so. In 2000, it was barely a blip on the radar, but by 2008 it accounted for 96 percent of all external radiation treatments for prostate cancer, according to the editorial.

…

IMRT is not, however, the latest radiation technique out there. That would be proton beam therapy, which is supposed to be even more targeted than IMRT — and is twice as expensive. But so far, research has suggested the newer technology is no better.

“There’s not a shred of evidence that it’s better than IMRT,” Cooperberg said.”

MedPage Today reported:

“Use of new technology to treat prostate cancer has come under increased scrutiny as questions have arisen about the balance between risks and benefits, as well as associated costs. One recent study showed that new technology in prostate cancer adds $350 million a year to healthcare costs (J Clin Oncol 2011; 29: 1517-1524).

The Institute of Medicine identified treatment of localized prostate cancer as a priority for comparative-effectiveness research (Institute for Clinical and Economic Review 2009).”

Note:  at the time I post this, this story has gained surprisingly little mainstream news media pickup in the US.  I found the two stories above, plus entries by Reuters Health and dailyRX.com.

Nearly three years ago, the Wall Street Journal reported:

“Taking advantage of an exemption in a federal law governing patient referrals, groups of urologists across the country have teamed up with radiation oncologists to capture the lucrative reimbursements IMRT commands from Medicare.

Under these arrangements, the urologists buy radiation equipment and hire radiation oncologists to administer it. They then refer their patients to their in-house staff for treatment. The bulk of Medicare’s reimbursements goes to the urologists as owners of the equipment.

There are now at least 37 such urology groups in 16 states, ranging in size from a few physicians to more than 100. Critics, including some independent radiation oncologists who are losing business, say the urology groups steer many patients toward IMRT for financial gain, drawn by Medicare payments that can reach $40,000 per patient, depending on the state.”

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