转移性肺癌姑息性胸部放疗不适当应用的患病率及预测因素
Prevalence and Predictors of Inappropriate Delivery of Palliative Thoracic Radiotherapy for Metastatic Lung Cancer.
作者信息
Koshy Matthew, Malik Renuka, Mahmood Usama, Husain Zain, Weichselbaum Ralph R, Sher David J
机构信息
Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL (MK, RRW); Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL (MK, RM, RRW); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (UM); Department of Radiation Oncology, Yale University, New Haven, CT (ZH); Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (DJS).
出版信息
J Natl Cancer Inst. 2015 Sep 30;107(12):djv278. doi: 10.1093/jnci/djv278. Print 2015 Dec.
BACKGROUND
High-level evidence has established well-recognized standard treatment regimens for patients undergoing palliative chest radiotherapy (RT) for stage IV non-small cell lung cancer (NSCLC), including treating with fewer than 15 fractions of RT, and not delivering concurrent chemoradiation (CRT) because of its increased toxicity and limited efficacy in the palliative setting.
METHODS
The study included patients in the National Cancer Database from 2004 to 2012 with stage IV lung cancer who received palliative chest radiation therapy. Logistic regression was performed to determine predictors of standard vs nonstandard regimens (>15 fractions or CRT). All statistical tests were two-sided.
RESULTS
There were 46 803 patients in the analysis and 49% received radiotherapy for longer than 15 fractions, and 28% received greater than 25 fractions. Approximately 19% received CRT. The strongest independent predictors of long-course RT were private insurance (odds ratio [OR] = 1.40 vs uninsured, 95% confidence interval [CI] = 1.28 to 1.53) and treatment in community cancer programs (OR = 1.49, 95% CI = 1.38 to 1.58) compared with academic research programs. The strongest factors that predicted for concurrent chemoradiotherapy were private insurance (OR = 1.38 95% CI = 1.23 to 1.54) compared with uninsured patients and treatment in community cancer programs (OR = 1.44, 95% CI = 1.33 to 1.56) compared with academic programs.
CONCLUSIONS
Approximately half of all patients with metastatic lung cancer received a higher number of radiation fractions than recommended. Patients with private insurance and treated in community cancer centers were more likely to receive longer courses of RT or CRT. This demonstrates that a substantial number of patients requiring palliative thoracic radiotherapy are overtreated and further work is necessary to ensure these patients are treated according to evidenced-based guidelines.
背景
高级别证据已为接受姑息性胸部放疗（RT）的IV期非小细胞肺癌（NSCLC）患者确立了公认的标准治疗方案，包括采用少于15次分割的放疗，并且不进行同步放化疗（CRT），因为在姑息治疗中其毒性增加且疗效有限。
方法
该研究纳入了2004年至2012年国家癌症数据库中接受姑息性胸部放疗的IV期肺癌患者。进行逻辑回归以确定标准方案与非标准方案（>15次分割或CRT）的预测因素。所有统计检验均为双侧检验。
结果
分析中有46803例患者，49%接受了超过15次分割的放疗，28%接受了超过25次分割的放疗。约19%接受了CRT。与学术研究项目相比，长期放疗的最强独立预测因素是私人保险（比值比[OR]=1.40，与未参保者相比，95%置信区间[CI]=1.28至1.53）以及在社区癌症项目中接受治疗（OR=1.49，95%CI=1.38至1.58）。预测同步放化疗的最强因素是与未参保患者相比的私人保险（OR=1.38，95%CI=1.23至1.54）以及与学术项目相比在社区癌症项目中接受治疗（OR=1.44，95%CI=1.33至1.56）。
结论
所有转移性肺癌患者中约有一半接受的放疗分割次数高于推荐次数。拥有私人保险且在社区癌症中心接受治疗的患者更有可能接受更长疗程的放疗或CRT。这表明大量需要姑息性胸部放疗的患者接受了过度治疗，有必要进一步开展工作以确保这些患者按照循证指南接受治疗。
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