Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA 02115, USA.
Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e197-206. doi: 10.1016/j.ijrobp.2011.02.007. Epub 2011 May 17.
The extent to which new techniques for the delivery of radiotherapy for head and neck squamous cell carcinoma (HNSCC) have diffused into clinical practice is unclear, including the use of 3-dimensional conformal RT (3D-RT) and intensity-modulated radiation therapy (IMRT).
Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we identified 2,495 Medicare patients with Stage I-IVB HNSCC diagnosed at age 65 years or older between 2000 and 2005 and treated with either definitive (80%) or adjuvant (20%) radiotherapy. Our primary aim was to analyze the trends and predictors of IMRT use over this time, and the secondary aim was a similar description of the trends and predictors of conformal radiotherapy (CRT) use, defined as treatment with either 3D-RT or IMRT.
Three hundred sixty-four (15%) patients were treated with IMRT, and 1,190 patients (48%) were treated with 3D-RT. Claims for IMRT and CRT rose from 0% to 33% and 39% to 86%, respectively, between 2000 and 2005. On multivariable analysis, IMRT use was associated with SEER region (West 18%; Northeast 11%; South 12%; Midwest 13%), advanced stage (advanced, 21%; early, 9%), non-larynx site (non-larynx, 23%; larynx, 7%), higher median census tract income (highest vs. lowest quartile, 18% vs. 10%), treatment year (2003-2005, 31%; 2000-2002, 6%), use of chemotherapy (26% with; 9% without), and higher radiation oncologist treatment volume (highest vs. lowest tertile, 23% vs. 8%). With CRT as the outcome, only SEER region, treatment year, use of chemotherapy, and increasing radiation oncologist HNSCC volume were significant on multivariable analysis.
The use of IMRT and CRT by Medicare beneficiaries with HNSCC rose significantly between 2000 and 2005 and was associated with both clinical and non-clinical factors, with treatment era and radiation oncologist HNSCC treatment volume serving as the strongest predictors of IMRT use.
新技术在头颈部鳞状细胞癌（HNSCC）放射治疗中的应用程度尚不清楚，包括三维适形放疗（3D-RT）和调强放疗（IMRT）的应用。
我们利用监测、流行病学和最终结果（SEER）-医疗保险数据库，确定了 2000 年至 2005 年间年龄在 65 岁及以上的 2495 例 I-IVB 期 HNSCC 患者，这些患者接受了根治性（80%）或辅助性（20%）放疗。我们的主要目的是分析在此期间使用 IMRT 的趋势和预测因素，次要目的是对使用适形放疗（CRT）的趋势和预测因素进行类似的描述，定义为接受 3D-RT 或 IMRT 治疗的患者。
364 例（15%）患者接受了 IMRT 治疗，1190 例（48%）患者接受了 3D-RT 治疗。2000 年至 2005 年间，IMRT 和 CRT 的索赔比例分别从 0%上升至 33%和从 39%上升至 86%。多变量分析显示，IMRT 的使用与 SEER 地区（西部 18%；东北部 11%；南部 12%；中西部 13%）、晚期（晚期 21%；早期 9%）、非喉部位（非喉 23%；喉 7%）、较高的中值普查区收入（最高与最低四分位数，18%与 10%）、治疗年份（2003-2005 年 31%；2000-2002 年 6%）、化疗的使用（26%与；9%无）以及较高的放射肿瘤学家治疗量（最高与最低三分位，23%与 8%）相关。以 CRT 为结果，只有 SEER 地区、治疗年份、化疗的使用和放射肿瘤学家治疗 HNSCC 的量的增加在多变量分析中具有显著意义。
2000 年至 2005 年间，医疗保险受益人的 HNSCC 患者中 IMRT 和 CRT 的使用显著增加，且与临床和非临床因素相关，其中治疗时代和放射肿瘤学家治疗 HNSCC 的量是 IMRT 使用的最强预测因素。
