Shaikh Talha, Handorf Elizabeth A, Murphy Colin T, Mehra Ranee, Ridge John A, Galloway Thomas J
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Int J Radiat Oncol Biol Phys. 2016 Dec 1;96(5):967-975. doi: 10.1016/j.ijrobp.2016.08.046. Epub 2016 Sep 6.
To assess the impact of radiation treatment time (RTT) in head and neck cancers on overall survival (OS) in the era of chemoradiation.
Patients with diagnoses of tongue, hypopharynx, larynx, oropharynx, or tonsil cancer were identified by use of the National Cancer Database. RTT was defined as date of first radiation treatment to date of last radiation treatment. In the definitive setting, prolonged RTT was defined as >56 days, accelerated RTT was defined as <47 days, and standard RTT was defined as 47 to 56 days. In the postoperative setting, prolonged RTT was defined as >49 days, accelerated RTT was defined as <40 days, and standard RTT was defined as 40 to 49 days. We used χ tests to identify predictors of RTT. The Kaplan-Meier method was used to compare OS among groups. Cox proportional hazards model was used for OS analysis in patients with known comorbidity status.
19,531 patients were included; 12,987 (67%) had a standard RTT, 4,369 (34%) had an accelerated RTT, and 2,165 (11%) had a prolonged RTT. On multivariable analysis, accelerated RTT (hazard ratio [HR] 0.84; 95% confidence interval [CI] 0.73-0.97) was associated with an improved OS, and prolonged RTT (HR 1.25; 95% CI 1.14-1.37) was associated with a worse OS relative to standard RTT. When the 9,200 (47%) patients receiving definitive concurrent chemoradiation were examined, prolonged RTT (HR 1.29; 95% CI 1.11-1.50) was associated with a worse OS relative to standard RTT, whereas there was no significant association between accelerated RTT and OS (HR 0.76; 95% CI 0.57-1.01).
Prolonged RTT is associated with worse OS in patients receiving radiation therapy for head and neck cancer, even in the setting of chemoradiation. Expeditious completion of radiation should continue to be a quality metric for the management of head and neck malignancies.
评估在放化疗时代，头颈部癌的放射治疗时间（RTT）对总生存期（OS）的影响。
利用国家癌症数据库确定诊断为舌癌、下咽癌、喉癌、口咽癌或扁桃体癌的患者。RTT定义为首次放疗日期至末次放疗日期。在根治性治疗中，延长的RTT定义为>56天，加速的RTT定义为<47天，标准RTT定义为47至56天。在术后治疗中，延长的RTT定义为>49天，加速的RTT定义为<40天，标准RTT定义为40至49天。我们使用χ检验来确定RTT的预测因素。采用Kaplan-Meier方法比较各组的OS。Cox比例风险模型用于已知合并症状态患者的OS分析。
纳入19531例患者；12987例（67%）为标准RTT，4369例（34%）为加速RTT，2165例（11%）为延长RTT。多变量分析显示，与标准RTT相比，加速RTT（风险比[HR]0.84；95%置信区间[CI]0.73-0.97）与OS改善相关，延长RTT（HR 1.25；95%CI 1.14-1.37）与OS较差相关。在对9200例（47%）接受根治性同步放化疗的患者进行检查时，与标准RTT相比，延长RTT（HR 1.29；95%CI 1.11-1.50）与OS较差相关，而加速RTT与OS之间无显著关联（HR 0.76；95%CI 0.57-1.01）。
头颈部癌放疗患者中，延长RTT与较差的OS相关，即使在放化疗情况下也是如此。迅速完成放疗应继续作为头颈部恶性肿瘤治疗的质量指标。
