Stokes William A, Abbott Diana, Phan Andy, Raben David, Lanning Ryan M, Karam Sana D
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
Colorado Biostatistics Consortium, Colorado School of Public Health, Aurora, Colorado.
Int J Radiat Oncol Biol Phys. 2017 Aug 1;98(5):1014-1021. doi: 10.1016/j.ijrobp.2017.03.050. Epub 2017 Apr 6.
To characterize practice patterns, including temporal trends, in fractionation schedules among patients in the United States undergoing definitive radiation therapy for early-stage glottic cancer and to compare overall survival outcomes between fractionation schedules.
We queried the National Cancer Database for patients with TisN0M0, T1N0M0, or T2N0M0 squamous cell carcinoma of the glottic larynx diagnosed between 2004 and 2012 and undergoing definitive radiation therapy. Dose per fraction was calculated to define cohorts undergoing conventional fractionation (CFxn) and hypofractionation (HFxn). Logistic regression was performed to identify predictors of receiving HFxn, and Cox regression was used to determine predictors of death. One-to-one propensity score matching was then used to compare survival between fractionation schedules.
The study included 10,539 patients, with 6576 undergoing CFxn and 3963 undergoing HFxn. Patients with T1 disease comprised a majority of each cohort. Use of HFxn increased significantly over the period studied (P<.001), but even in the final year, nearly one-half of patients continued to receive CFxn. Receipt of HFxn was also independently associated with higher income and facility types other than community cancer programs on logistic regression. On multivariate Cox regression, HFxn was associated with improved survival (hazard ratio [HR] for death, 0.90; 95% confidence interval [CI], 0.83-0.97; P=.008), a finding redemonstrated on univariate Cox regression among a well-matched cohort after propensity score matching (HR, 0.88; 95% CI, 0.80-0.96; P=.003). Subgroup Cox multivariate analysis demonstrated a significant survival advantage with HFxn among patients with T1 disease (HR, 0.90; 95% CI, 0.81-0.99; P=.042) but a nonsignificant benefit among those with Tis (HR, 0.86; 95% CI, 0.57-1.30; P=.472) or T2 (HR, 0.88; 95% CI, 0.76-1.02; P=.099) disease.
Use of HFxn is increasing and is associated with improved survival over CFxn. Our findings support the broadened use of HFxn for patients with early-stage glottic cancer undergoing definitive radiation therapy.
描述美国接受早期声门癌根治性放射治疗患者的分割方案的实践模式，包括时间趋势，并比较不同分割方案之间的总生存结果。
我们查询了国家癌症数据库，以获取2004年至2012年间诊断为TisN0M0、T1N0M0或T2N0M0声门鳞状细胞癌并接受根治性放射治疗的患者。计算每分次剂量以定义接受常规分割（CFxn）和大分割（HFxn）的队列。进行逻辑回归以确定接受HFxn的预测因素，并使用Cox回归确定死亡的预测因素。然后使用一对一倾向评分匹配来比较不同分割方案之间的生存情况。
该研究纳入了10539例患者，其中6576例接受CFxn，3963例接受HFxn。T1期疾病患者在每个队列中占大多数。在研究期间，HFxn的使用显著增加（P<.001），但即使在最后一年，仍有近一半的患者继续接受CFxn。在逻辑回归中，接受HFxn还与较高的收入和社区癌症项目以外的机构类型独立相关。在多变量Cox回归中，HFxn与生存改善相关（死亡风险比[HR]为0.90；95%置信区间[CI]为0.83-0.97；P=.008），这一发现在倾向评分匹配后的匹配良好队列中的单变量Cox回归中得到再次证实（HR为0.88；95%CI为0.80-0.96；P=.003）。亚组Cox多变量分析显示，在T1期疾病患者中，HFxn具有显著的生存优势（HR为0.90；95%CI为0.81-0.99；P=.042），但在Tis期（HR为0.86；95%CI为0.57-1.30；P=.472）或T2期（HR为0.88；95%CI为0.76-1.02；P=.099）疾病患者中获益不显著。
HFxn的使用正在增加，并且与CFxn相比生存改善相关。我们的研究结果支持在接受根治性放射治疗的早期声门癌患者中更广泛地使用HFxn。
