Gill Beant S, Chapman Bhavana V, Hansen Karyn J, Sukumvanich Paniti, Beriwal Sushil
Department of Radiation Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Gynecologic Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA.
Brachytherapy. 2015 May-Jun;14(3):373-9. doi: 10.1016/j.brachy.2014.12.003. Epub 2015 Jan 15.
The National Cancer Data Base (NCDB) was analyzed to evaluate practice patterns and the impact of radiotherapy modalities for endometrial cancer treated with primary radiotherapy.
The NCDB was queried for Stage I endometrioid adenocarcinoma patients treated with primary radiotherapy without surgery from 1998 to 2006. Brachytherapy (BT) utilization factors were established using multivariable logistic regression. Log-rank and Cox proportional hazards modeling were used to assess variables impacting survival.
A total of 853 patients were analyzed: 23.7%, 31.3%, and 45.0% received BT alone, external beam radiotherapy (EBRT) and BT, or EBRT alone. The BT utilization ranged from 40.5% to 51.9% over time (p=0.70). Lower utilization was associated with advanced age (≥80 years: odds ratio [OR] 0.43, 95% confidence interval [CI] 0.28-0.65, p<0.01) and facilities with volume in the bottom quartile (OR 0.44, 95% CI 0.30-0.66, p<0.01). Utilization was higher among patients living more than 30 miles from the facilities (OR 2.14, 95%CI 1.35-3.42, p<0.01). With 36-month median followup, unadjusted median survivals for EBRT dose of 30Gy or lower, EBRT dose higher than 30Gy, BT, and EBRT+BT were 12.6, 31.1, 44.6, and 57.1 months (p<0.01). After correcting for other factors, higher risk of mortality was seen with EBRT dose of 30Gy or lower (hazard ratio [HR]2.75, 95% CI 1.66-4.55, p<0.01) and EBRT dose higher than 30Gy (HR 1.43, 95% CI 1.07-1.91, p=0.02) compared with EBRT+BT. No difference was seen using BT alone (HR 1.29, 95% CI 0.92-1.79, p=0.14).
BT utilization for nonsurgically managed endometrial cancer remains low with most patients receiving EBRT alone. Despite concerns of overtreatment in a population with competing causes of death, BT appears to improve survival.
分析美国国立癌症数据库（NCDB），以评估子宫内膜癌接受单纯放疗时的治疗模式及放疗方式的影响。
查询NCDB中1998年至2006年接受单纯放疗而非手术治疗的Ⅰ期子宫内膜样腺癌患者。采用多变量逻辑回归确定近距离放疗（BT）的使用因素。使用对数秩检验和Cox比例风险模型评估影响生存的变量。
共分析853例患者：23.7%、31.3%和45.0%的患者分别接受单纯BT、外照射放疗（EBRT）联合BT或单纯EBRT。随时间推移，BT使用率在40.5%至51.9%之间（p = 0.70）。较低的使用率与高龄（≥80岁：比值比[OR]0.43，95%置信区间[CI]0.28 - 0.65，p < 0.01）以及放疗量处于四分位下限的机构有关（OR 0.44，95% CI 0.30 - 0.66，p < 0.01）。居住在距离机构超过30英里的患者使用率较高（OR 2.14，95% CI 1.35 - 3.42，p < 0.01）。中位随访36个月，EBRT剂量为30Gy或更低、EBRT剂量高于30Gy、BT以及EBRT + BT的未调整中位生存期分别为12.6、31.1、44.6和57.1个月（p < 0.01）。校正其他因素后，与EBRT + BT相比，EBRT剂量为30Gy或更低（风险比[HR]2.75，95% CI 1.66 - 4.55，p < 0.01）和EBRT剂量高于30Gy（HR 1.43，95% CI 1.07 - 1.91，p = 0.02）的患者死亡风险更高。单纯使用BT未见差异（HR 1.29，95% CI 0.92 - 1.79，p = 0.14）。
非手术治疗的子宫内膜癌患者中BT使用率仍然较低，大多数患者仅接受EBRT。尽管担心在有其他死亡原因的人群中存在过度治疗，但BT似乎可提高生存率。
