Boero Isabel J, Paravati Anthony J, Xu Beibei, Cohen Ezra E W, Mell Loren K, Le Quynh-Thu, Murphy James D
Isabel J. Boero, Anthony J. Paravati, Ezra E.W. Cohen, Loren K. Mell, and James D. Murphy, University of California San Diego, La Jolla; Quynh-Thu Le, Stanford University, Stanford, CA; and Beibei Xu, Peking University, Beijing, People's Republic of China.
J Clin Oncol. 2016 Mar 1;34(7):684-90. doi: 10.1200/JCO.2015.63.9898. Epub 2016 Jan 4.
Over the past decade, intensity-modulated radiation therapy (IMRT) has replaced conventional radiation techniques in the management of head-and-neck cancers (HNCs). We conducted this population-based study to evaluate the influence of radiation oncologist experience on outcomes in patients with HNC treated with IMRT compared with patients with HNC treated with conventional radiation therapy.
We identified radiation providers from Medicare claims of 6,212 Medicare beneficiaries with HNC treated between 2000 and 2009. We analyzed the impact of provider volume on all-cause mortality, HNC mortality, and toxicity end points after treatment with either conventional radiation therapy or IMRT. All analyses were performed by using either multivariable Cox proportional hazards or Fine-Gray regression models controlling for potential confounding variables.
Among patients treated with conventional radiation, we found no significant relationship between provider volume and patient survival or any toxicity end point. Among patients receiving IMRT, those treated by higher-volume radiation oncologists had improved survival compared with those treated by low-volume providers. The risk of all-cause mortality decreased by 21% for every additional five patients treated per provider per year (hazard ratio [HR], 0.79; 95% CI, 0.67 to 0.94). Patients treated with IMRT by higher-volume providers had decreased HNC-specific mortality (subdistribution HR, 0.68; 95% CI, 0.50 to 0.91) and decreased risk of aspiration pneumonia (subdistribution HR, 0.72; 95% CI, 0.52 to 0.99).
Patients receiving IMRT for HNC had improved outcomes when treated by higher-volume providers. These findings will better inform patients and providers when making decisions about treatment, and emphasize the critical importance of high-quality radiation therapy for optimal treatment of HNC.
在过去十年中，调强放射治疗（IMRT）已取代传统放射技术用于头颈部癌（HNC）的治疗。我们开展了这项基于人群的研究，以评估放射肿瘤学家的经验对接受IMRT治疗的HNC患者与接受传统放射治疗的HNC患者预后的影响。
我们从2000年至2009年间接受治疗的6212名患有HNC的医疗保险受益人的医疗保险理赔记录中识别出放射治疗提供者。我们分析了提供者治疗量对接受传统放射治疗或IMRT治疗后的全因死亡率、HNC死亡率和毒性终点的影响。所有分析均使用多变量Cox比例风险模型或Fine-Gray回归模型进行，以控制潜在的混杂变量。
在接受传统放射治疗的患者中，我们发现提供者治疗量与患者生存率或任何毒性终点之间没有显著关系。在接受IMRT的患者中，与由治疗量低的提供者治疗的患者相比，由治疗量高的放射肿瘤学家治疗的患者生存率有所提高。每位提供者每年每多治疗5名患者，全因死亡率风险降低21%（风险比[HR]，0.79；95%置信区间，0.67至0.94）。由治疗量高的提供者进行IMRT治疗的患者HNC特异性死亡率降低（亚分布HR，0.68；95%置信区间，0.50至0.91），吸入性肺炎风险降低（亚分布HR，0.72；95%置信区间，0.52至0.99）。
接受IMRT治疗的HNC患者由治疗量高的提供者治疗时预后更好。这些发现将在患者和提供者做出治疗决策时提供更好的信息，并强调高质量放射治疗对HNC最佳治疗的至关重要性。
