Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Cancer. 2014 Jul 15;120(14):2114-21. doi: 10.1002/cncr.28697. Epub 2014 Apr 15.
Brachytherapy has been shown to be an efficacious and cost-effective treatment among patients with localized prostate cancer. In this study, the authors examined trends in brachytherapy use for localized prostate cancer using a large national cancer registry.
In the National Cancer Data Base (NCDB), a total of 1,547,941 patients with localized prostate cancer were identified from 1998 through 2010. Excluding patients with lymph node-positive or metastatic disease, the authors examined primary treatment trends focusing on the use of brachytherapy over time. Patients with available data (2004-2009) were stratified by National Comprehensive Cancer Network risk criteria. Controlling for year of diagnosis and demographic, clinical, and pathologic characteristics, multivariate analyses were performed examining the association between patient characteristics and receipt of brachytherapy.
In the study cohort, brachytherapy use reached a peak of 16.7% in 2002, and then steadily declined to a low of 8% in 2010. Of the 719,789 patients with available data for risk stratification, 41.1%, 35.3%, and 23.6%, respectively, met low, intermediate, and high National Comprehensive Cancer Network risk criteria. After adjustment, patients of increasing age and those with Medicare insurance were more likely to receive brachytherapy. In contrast, patients with intermediate-risk or high-risk disease, Medicaid insurance, increasing comorbidity count, and increasing year of diagnosis were less likely to receive brachytherapy.
For patients with localized prostate cancer who are treated at National Cancer Data Base institutions, there has been a steady decline in brachytherapy use since 2003. For low-risk patients, the declining use of brachytherapy monotherapy compared with more costly emerging therapies has significant health policy implications.
近距离放射治疗已被证明在局部前列腺癌患者中是一种有效且具有成本效益的治疗方法。在这项研究中，作者使用大型国家癌症登记处检查了局部前列腺癌近距离放射治疗使用的趋势。
在国家癌症数据库（NCDB）中，从 1998 年到 2010 年共确定了 1547941 名局部前列腺癌患者。排除淋巴结阳性或转移性疾病的患者后，作者检查了随着时间推移以近距离放射治疗为重点的主要治疗趋势。对 2004-2009 年有可用数据的患者按国家综合癌症网络风险标准进行分层。在控制诊断年份和人口统计学、临床和病理特征的情况下，进行了多变量分析，以检查患者特征与接受近距离放射治疗之间的关联。
在研究队列中，近距离放射治疗的使用率在 2002 年达到 16.7%的峰值，然后稳定下降到 2010 年的 8%的低点。在 719789 名有风险分层可用数据的患者中，分别有 41.1%、35.3%和 23.6%符合低、中、高国家综合癌症网络风险标准。调整后，年龄较大的患者和有医疗保险的患者更有可能接受近距离放射治疗。相比之下，患有中危或高危疾病、医疗补助保险、合并症计数增加和诊断年份增加的患者不太可能接受近距离放射治疗。
对于在国家癌症数据库机构接受治疗的局部前列腺癌患者，自 2003 年以来，近距离放射治疗的使用一直在稳步下降。对于低危患者，与成本更高的新兴疗法相比，近距离放射治疗单一疗法的使用减少对卫生政策具有重要意义。
