Kale Minal S, Mhango Grace, Bonomi Marcelo, Federman Alex, Sigel Keith, Rosenzweig Kenneth E, Wisnivesky Juan P
1 Division of General Internal Medicine, Department of Medicine.
2 Division of Hematology and Oncology, Wake Forest University, Winston-Salem, North Carolina.
Ann Am Thorac Soc. 2016 Sep;13(9):1593-9. doi: 10.1513/AnnalsATS.201603-156OC.
In the treatment of stage III non-small cell lung cancer (NSCLC), three-dimensional conformal radiotherapy (3D-RT) is the standard method for radiation delivery; however, intensity-modulated radiotherapy (IMRT) has been rapidly adopted. These two modalities may lead to similar survival, warranting a closer scrutiny of the costs involved.
The purpose of this study is to compare radiotherapy-related and total costs of older patients with NSCLC treated with 3D-RT versus IMRT.
We conducted a population-based study of all Medicare beneficiaries aged 65 years or older in a Surveillance, Epidemiology and End Results region. Patients were diagnosed with stage III NSCLC diagnosed between 2002 and 2009. Patients received IMRT or 3D-RT in combination with chemotherapy within 4 months of diagnosis. Radiotherapy-related and total adjusted cost and survival of patients receiving 3D-RT versus IMRT were compared using propensity scores methods.
Of the 2,418 patients in study, 314 (13%) received IMRT. Adjusted analyses showed no difference in overall survival (hazard ratio, 0.97; 95% confidence interval [CI], 0.85-1.12) in patients treated with 3D-RT versus IMRT. After adjusting for propensity scores, RT-related costs (estimated difference, $6,850; 95% CI, $5,532-$8,168) and total costs (estimated difference, $8,713; 95% CI, $4,376-$13,051) were significantly higher among patients undergoing IMRT.
The rapid adoption of IMRT for the treatment of stage III NSCLC has occurred in the absence of evidence from prospective randomized trials. Our results show that IMRT is associated with similar survival but increased costs, underscoring the need for continued research in IMRT and other new technologies.
在III期非小细胞肺癌（NSCLC）的治疗中，三维适形放疗（3D-RT）是放射治疗的标准方法；然而，调强放疗（IMRT）已被迅速采用。这两种方式可能导致相似的生存率，因此有必要对相关成本进行更仔细的审查。
本研究的目的是比较接受3D-RT与IMRT治疗的老年NSCLC患者的放疗相关成本和总成本。
我们在一个监测、流行病学和最终结果区域对所有65岁及以上的医疗保险受益人进行了一项基于人群的研究。患者在2002年至2009年期间被诊断为III期NSCLC。患者在诊断后4个月内接受IMRT或3D-RT联合化疗。使用倾向评分方法比较接受3D-RT与IMRT的患者的放疗相关成本和总调整成本及生存率。
在研究的2418名患者中，314名（13%）接受了IMRT。调整分析显示，接受3D-RT与IMRT治疗的患者的总生存率无差异（风险比，0.97；95%置信区间[CI]，0.85-1.12）。在调整倾向评分后，接受IMRT的患者的放疗相关成本（估计差异，6850美元；95%CI，5532-8168美元）和总成本（估计差异，8713美元；95%CI，4376-13051美元）显著更高。
在没有前瞻性随机试验证据的情况下，IMRT已迅速被用于III期NSCLC的治疗。我们的结果表明，IMRT与相似的生存率相关，但成本增加，这突出了对IMRT和其他新技术继续进行研究的必要性。
