Patankar Sonali S, Tergas Ana I, Deutsch Israel, Burke William M, Hou June Y, Ananth Cande V, Huang Yongmei, Neugut Alfred I, Hershman Dawn L, Wright Jason D
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States.
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
Gynecol Oncol. 2015 Mar;136(3):534-41. doi: 10.1016/j.ygyno.2014.12.038. Epub 2015 Jan 6.
Brachytherapy plays an important role in the treatment of cervical cancer. While small trials have shown comparable survival outcomes between high (HDR) and low-dose rate (LDR) brachytherapy, little data is available in the US. We examined the utilization of HDR brachytherapy and analyzed the impact of type of brachytherapy on survival for cervical cancer.
Women with stages IB2-IVA cervical cancer treated with primary (external beam and brachytherapy) radiotherapy between 2003-2011 and recorded in the National Cancer Database (NCDB) were analyzed. Generalized linear mixed models and Cox proportional hazards regression were used to examine predictors of HDR brachytherapy use and the association between HDR use and survival.
A total of 10,564 women including 2681 (25.4%) who received LDR and 7883 (74.6%) that received HDR were identified. Use of HDR increased from 50.2% in 2003 to 83.9% in 2011 (P<0.0001). In a multivariable model, year of diagnosis was the strongest predictor of use of HDR. While patients in the Northeast were more likely to receive HDR therapy, there were no other clinical or socioeconomic characteristics associated with receipt of HDR. In a multivariable Cox model, survival was similar between the HDR and LDR groups (HR=0.93; 95% CI 0.83-1.03). Similar findings were noted in analyses stratified by stage and histology. Kaplan-Meier analyses demonstrated no difference in survival based on type of brachytherapy for stage IIB (P=0.68), IIIB (P=0.17), or IVA (P=0.16) tumors.
The use of HDR therapy has increased rapidly. Overall survival is similar for LDR and HDR brachytherapy.
近距离放射治疗在宫颈癌治疗中发挥着重要作用。虽然小型试验显示高剂量率（HDR）和低剂量率（LDR）近距离放射治疗的生存结果相当，但美国的相关数据很少。我们研究了HDR近距离放射治疗的使用情况，并分析了近距离放射治疗类型对宫颈癌生存的影响。
分析了2003年至2011年间在国家癌症数据库（NCDB）中记录的接受原发性（外照射和近距离放射治疗）放疗的IB2-IVA期宫颈癌女性患者。使用广义线性混合模型和Cox比例风险回归来研究HDR近距离放射治疗使用的预测因素以及HDR使用与生存之间的关联。
共确定了10564名女性，其中2681名（25.4%）接受了LDR，7883名（74.6%）接受了HDR。HDR的使用从2003年的50.2%增加到2011年的83.9%（P<0.0001）。在多变量模型中，诊断年份是HDR使用的最强预测因素。虽然东北部的患者更有可能接受HDR治疗，但没有其他与接受HDR相关的临床或社会经济特征。在多变量Cox模型中，HDR组和LDR组的生存率相似（HR=0.93；95%CI 0.83-1.03）。在按阶段和组织学分层的分析中也发现了类似的结果。Kaplan-Meier分析表明，对于IIB期（P=0.68）、IIIB期（P=0.17）或IVA期（P=0.16）肿瘤，基于近距离放射治疗类型的生存率没有差异。
HDR治疗的使用迅速增加。LDR和HDR近距离放射治疗的总体生存率相似。
