Whether the Proton Beam Radiation Leads to Less Second Malignancies among Localized Prostate Cancer Patients Pubblico
Sun, Yuxian (Spring 2020)
Published
Abstract
Background: The primary radiotherapies for prostate cancer patients include three-dimensional
conformal radiation therapy (3D-CRT), Intensity-modulated radiation therapy (IMRT), Photon beam
radiation therapy (Photon therapy), Brachytherapy, and Proton beam radiation therapy (Proton therapy).
Although these treatment methods can be curative, radiation carcinogenesis arises as a unique major
concern.
Methods and Materials: NCDB prostate PUF cancer cases diagnosed from 2004 to 2016 were queried
for patient with localized disease and treated by radiation as the first course of treatment plan. ANOVA
and chi-square tests were used to assess the univariate association of radiotherapies and all covariates.
Absolute Standardized Difference was used to check the significance of the association. The univariate
logistic regression and multivariate logistic regression methods were used to assess the association of
secondary tumor with all covariates. Subgroup analysis was also performed. The pairwise propensity
score method was used to reduce selection bias through balancing baseline covariates.
Results: Proton therapy resulted in reduced odds of secondary cancers when compared to other radiation
therapies. After applying the propensity score weighting method, selection bias was eliminated (all ASD
below 0.2). Photon/IMRT/3D-CRT resulted in higher odds of secondary cancers when compared with
Proton therapy (OR: 4.31 (95%CI: 4.07-4.56)). In comparing Brachytherapy versus Proton therapy as the
reference group, the odds of secondary tumors were also statistically significant (OR: 3.45 (95%CI:3.21-
3.70)). The association of secondary tumor was modified by the race-ethic groups, the year of diagnosis
groups, and the gleason groups in comparison to Proton vs. Photon/IMRT/3D-CRT and Proton vs.
Brachy. NH-White patients had higher odds ratio with Photon/IMRT/3D-CRT therapy (OR:5.04 (95%CI:
4.73-5.37)) or Brachytherapy (OR:3.95 (95%CI: 3.64-4.28)) comparing with Proton therapy. Patients
from earlier year of diagnosis had higher odds ratio due to longer follow-up. Patients with lower Gleason
score had much higher odds ratio in comparison to Proton vs. Photon/IMRT/3D-CRT (OR:6.64 (95%CI:
6.02-7.34)) and Proton vs. Brachy (OR:5.12 (95%CI: 4.54-5.77)).
Conclusion: Proton therapy had the least risk of developing secondary tumors compared with therapies of
other radiation modalities. The propensity score weighting method could eliminate bias in observation
since our data was well balanced with propensity score adjustment.
Table of Contents
1. Introduction ................................................................................................................................ 1
2. Method ........................................................................................................................................ 3
2.1 Data Source .......................................................................................................................... 3
2.2 Study population .................................................................................................................. 4
2.3 Outcome Measures............................................................................................................... 4
2.4 Study Cohorts ....................................................................................................................... 5
2.5 Study Variables .................................................................................................................... 5
2.6 Statistical Method ................................................................................................................ 6
3. Results ......................................................................................................................................... 8
3.1 Overall patients’ baseline characteristics and differences by study cohorts. (Table 1) . 8
3.2 Association with the rate of the secondary tumor in the original sample. (Figure 1,
Figure 2, Table 2) ....................................................................................................................... 9
3.3 Association with the rate of the secondary tumor in propensity score weighted sample.
(Figure 3, Table 3) .................................................................................................................... 10
4. Discussion ................................................................................................................................. 11
5. Conclusion ................................................................................................................................ 13
6. Reference .................................................................................................................................. 13
7. Figures and Tables ................................................................................................................... 15
About this Master's Thesis
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