JNCI ：质子放射治疗可以将前列腺癌患者的副作用降到很低水平

耶鲁大学医学院的研究人员在国家癌症研究所的杂志上报告，与接受标准放射治疗[名为调强放疗（IMRT）]的患者相比，接受质子放疗（费用高昂）的患者的副作用，例如尿失禁和勃起功能障碍能缓解到最低程度。

众所周知，男性前列腺癌的标准治疗—根治性前列腺切除术和调强放疗—会导致尿失禁和勃起功能障碍之类的副作用。质子放射治疗的支持者认为，质子的物理性质可能减少这些常见的副作用。

“质子放射治疗变得越来越普及，国内建立了越来越多的质子放射治疗中心。”研究的主要作者、耶鲁大学癌症中心放射治疗部门副教授以及耶鲁大学癌症预后、公共政策和有效性研究（COPPER）中心会员James Yu医生（MD）说，“。然而，目前尚无令人信服的证据表明质子放射治疗是否优于调强放射治疗。”

为了寻找答案，耶鲁大学COPPER团队研究了全国大约30000名医疗保险的男性患者，纳入对象是2008年至2009年间因前列腺癌接受调强放射治疗或质子放射治疗的男性患者。在这段时间内，美国共有6家提供质子放射治疗的中心，并且作者发现，一些男性患者为了接受这种治疗而横穿整个国家。

研究团队发现，质子放射治疗组患者治疗6个月后的并发症发生率轻度降低，但是治疗12个月后，两个治疗组间（质子放射治疗组和调强放射治疗）并发症发生率无明显差异。尽管在治疗的副作用方面患者没有获得长期受益，但是与一个疗程调强放射治疗不到19000美金的费用相比，医疗保险对一个疗程质子放射治疗需要支付超过32000美金的高额费用。

“对于这些结果，我们感到十分惊讶。”本研究资深作者以及COPPER中心合作主任Cary Gross说，“癌症中心将投资超过1亿美金来建立他们自己的质子中心。传统观念认为质子放射治疗优于调强放射治疗，因此即使路途遥远患者也愿意来接受质子放射治疗。我们的研究结果提示，目前质子放射治疗有些过热；目前仍要需要经过10年或15年的观察，比较质子放射治疗和调强放射治疗的疗效。”

与前列腺癌相关的拓展阅读：

• Radiother Oncol：膀胱充盈增加局部高危前列腺癌患者盆腔放疗后的急性毒性反应
• J Urol.：新的诊断创新可改进医生检测前列腺癌的方式
• NEJM：阿比特龙可使早期前列腺癌患者有显著获益
• 上海：20年间前列腺癌发病率翻了12倍多
• Science：科学家揪出前列腺癌罪魁祸首
更多信息请点击：有关前列腺癌更多资讯

DOI:10.1093/jnci/djs463
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Proton Versus Intensity-Modulated Radiotherapy for Prostate Cancer: Patterns of Care and Early Toxicity

James B. Yu, Pamela R. Soulos, Jeph Herrin, Laura D. Cramer,Arnold L. Potosky, Kenneth B. Roberts and Cary P. Gross

Background Proton radiotherapy (PRT) is an emerging treatment for prostate cancer despite limited knowledge of clinical benefit or potential harms compared with other types of radiotherapy. We therefore compared patterns of PRT use, cost, and early toxicity among Medicare beneficiaries with prostate cancer with those of intensity-modulated radiotherapy (IMRT).Methods We performed a retrospective study of all Medicare beneficiaries aged greater than or equal to 66 years who received PRT or IMRT for prostate cancer during 2008 and/or 2009. We used multivariable logistic regression to identify factors associated with receipt of PRT. To assess toxicity, each PRT patient was matched with two IMRT patients with similar clinical and sociodemographic characteristics. The main outcome measures were receipt of PRT or IMRT, Medicare reimbursement for each treatment, and early genitourinary, gastrointestinal, and other toxicity. All statistical tests were two-sided.Results We identified 27,647 men; 553 (2%) received PRT and 27,094 (98%) received IMRT. Patients receiving PRT were younger, healthier, and from more affluent areas than patients receiving IMRT. Median Medicare reimbursement was $32,428 for PRT and $18,575 for IMRT. Although PRT was associated with a statistically significant reduction in genitourinary toxicity at 6 months compared with IMRT (5.9% vs 9.5%; odds ratio [OR] = 0.60, 95% confidence interval [CI] = 0.38 to 0.96, P = .03), at 12 months post-treatment there was no difference in genitourinary toxicity (18.8% vs 17.5%; OR = 1.08, 95% CI = 0.76 to 1.54, P = .66). There was no statistically significant difference in gastrointestinal or other toxicity at 6 months or 12 months post-treatment.Conclusions Although PRT is substantially more costly than IMRT, there was no difference in toxicity in a comprehensive cohort of Medicare beneficiaries with prostate cancer at 12 months post-treatment.