Swanick Cameron W, Eifel Patricia J, Huo Jinhai, Meyer Larissa A, Smith Grace L
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Gynecol Oncol. 2017 Jul;146(1):87-93. doi: 10.1016/j.ygyno.2017.05.004. Epub 2017 May 12.
To examine adjuvant radiation therapy (RT) use, patterns of RT delivery, and clinical outcomes in older patients with node-positive vulvar cancer.
Using SEER-Medicare linked data, we identified 444 patients (age≥66years) with node-positive squamous cell vulvar carcinoma, without distant metastases, and treated with primary surgery between 1991 and 2009. We used claims to examine RT use and the following delivery metrics: 1) completion of ≥20 fractions, 2) treatment duration <8weeks, 3) <1week of intra-treatment break, and 4) treatment interval from surgery to start of RT <8weeks. We tested associations between RT use and metrics with overall (OS) and cause-specific survival (CSS) using multivariate proportional hazards regression.
Median age was 78years (interquartile range [IQR]=74-83). Median follow-up was 17months (IQR=9-40). Three hundred six patients (69%) received RT. Three delivery metrics were associated with improved outcomes: completion of ≥20 fractions, treatment duration <8weeks, and <1week of intra-treatment break. Patients who achieved these 3 metrics demonstrated better disease outcomes compared with surgery alone (OS hazard ratio [HR] for death=0.62, 95% confidence interval [CI]=0.46-0.82, P=0.001; CSS HR=0.58, 95% CI=0.40-0.85,P=0.005). Patients not achieving RT metrics demonstrated marginal improvements in disease outcomes over surgery alone (OS HR=0.73, 95% CI=0.55-0.99,P=0.04; CSS HR=0.76, 95% CI=0.52-1.11, P=0.16). Notably, only 51% of patients who received RT achieved all benchmarks.
In this cohort of older women with node-positive vulvar cancer, achieving metrics for RT delivery was an important factor for optimizing disease benefits from treatment.
研究老年淋巴结阳性外阴癌患者辅助放疗（RT）的使用情况、放疗实施模式及临床结局。
利用监测、流行病学和最终结果（SEER）医保链接数据，我们确定了444例年龄≥66岁、无远处转移且于1991年至2009年间接受原发手术治疗的淋巴结阳性外阴鳞状细胞癌患者。我们利用索赔数据来研究放疗的使用情况以及以下放疗实施指标：1）完成≥20次分割；2）治疗持续时间<8周；3）治疗期间中断<1周；4）手术至放疗开始的治疗间隔<8周。我们使用多变量比例风险回归来检验放疗使用及指标与总生存期（OS）和特定病因生存期（CSS）之间的关联。
中位年龄为78岁（四分位间距[IQR]=74-83）。中位随访时间为17个月（IQR=9-40）。306例患者（69%）接受了放疗。三个放疗实施指标与改善结局相关：完成≥20次分割、治疗持续时间<8周以及治疗期间中断<1周。达到这三个指标的患者与单纯手术相比，疾病结局更好（死亡的OS风险比[HR]=0.62，95%置信区间[CI]=0.46-0.82，P=0.001；CSS HR=0.58，95%CI=0.40-0.85，P=0.005）。未达到放疗指标的患者与单纯手术相比，疾病结局略有改善（OS HR=0.73，95%CI=0.55-0.99，P=0.04；CSS HR=0.76，95%CI=0.52-1.11，P=0.16）。值得注意的是，接受放疗的患者中只有51%达到了所有标准。
在这组老年淋巴结阳性外阴癌女性患者中，达到放疗实施指标是优化治疗疾病获益的重要因素。
