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National population-based study comparing treatment-related toxicity in men who received Intensity-Modulated versus 3D-Conformal Radical Radiotherapy for prostate cancer

Research output: Contribution to journalArticle

A. Sujenthiran, J. Nossiter, S.C. Charman, M. Parry, P. Dasgupta, J. van der Meulen, P.J. Cathcart, N.W. Clarke, H. Payne, A. Aggarwal

Original languageEnglish
JournalInternational Journal of Radiation Oncology Biology Physics
Early online date1 Sep 2017
Publication statusE-pub ahead of print - 1 Sep 2017


King's Authors


Purpose: There has been a rapid adoption of Intensity-modulated radiotherapy (IMRT) despite a lack of robust evidence demonstrating superiority over 3D-Conformal radiotherapy (3D-CRT). The aim of this national population-based study was to compare severe genitourinary (GU) and gastrointestinal (GI) toxicity in patients with prostate cancer who were treated with radical IMRT or 3D-CRT.

Methods and Materials: Patients treated with IMRT (n=6,933) or 3D-CRT (n=16,289) between January 1 2010 to December 31 2013 in the English National Health Service (NHS) were identified using cancer registry data, the National Radiotherapy Dataset and Hospital Episodes Statistics (HES), the administrative database of care episodes in NHS hospitals. We developed a coding system that identifies severe toxicity (at least Grade 3 according to the NCI CTCAE scoring system) based on the presence of a procedure and a corresponding diagnostic code in patients’ HES records after radiotherapy. A competing risks regression analysis was used to estimate hazard ratios (HR), comparing the incidence of severe GI and GU complications following IMRT and 3D-CRT, adjusting for patient, disease, and treatment characteristics.

Results: The use of IMRT, as opposed to 3D-CRT, increased from 3.1% in 2010 to 64.7% in 2013. Patients who received IMRT were less likely than those receiving 3D-CRT to experience severe GI toxicity (4.9 vs 6.5 per 100 person-years; adjusted HR 0.66; 95%CI 0.61-0.72) but had similar levels of GU toxicity (2.3 vs 2.4 per 100 person-years; adjusted HR 0.94; 95%CI 0.84-1.06).

Conclusions: Prostate cancer patients who received radical radiotherapy using IMRT were less likely to experience severe GI toxicity and they had similar GU toxicity compared to those who received 3D-CRT. These findings in an unselected “real-world” population support the use of IMRT, but further cost-effectiveness studies are urgently required.

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