Wang Yao-Ching, Li Chia-Chin, Chien Chun-Ru
1 Department of Radiation Oncology, China Medical University Hospital , Taichung , Taiwan.
2 Department of Biomedical Imaging and Radiological Science, College of Health Care, China Medical University , Taichung , Taiwan.
Br J Radiol. 2018 Jun;91(1086):20170947. doi: 10.1259/bjr.20170947. Epub 2018 May 17.
This study used a population-based propensity score (PS)-matched analysis to compare the effectiveness of tomotherapy-based image-guided intensity-modulated radiotherapy (referred to as T-IMRT) with that of linear accelerator based (referred to as L-IMRT) for clinically localized pharyngeal cancer (LPC, divided into nasopharyngeal cancer and non-nasopharyngeal cancer) with definitive concurrent chemoradiotherapy (CCRT).
Eligible LPC patients diagnosed between 2007 and 2014 were identified among all citizens in Taiwan from the Health and Welfare Data Science Center database. A PS-matched sample based on the PS estimated from the covariables of interest was constructed to compare the effectiveness of T-IMRT with L-IMRT. In the primary analysis, overall survival (OS) was compared for assessment of effectiveness. We also evaluated freedom from local regional recurrence and pharyngeal cancer-specific survival and performed supplementary analyses.
The study population included 960 patients equally divided into two groups. OS did not differ significantly between the T-IMRT and L-IMRT groups (hazard ratio for death: 0.82, p = 0.15, 5-year OS rate: 79 and 74% for T-IMRT and L-IMRT, respectively), and there were no significant differences in the other endpoints or supplementary analyses.
For LPC patients treated with definitive CCRT, we found no significant difference in disease control or survival between the T-IMRT and L-IMRT groups. However, further studies, especially randomized trials or studies focusing on other dimensions, such as quality of life, are needed. Advances in knowledge: We provide the first population-based study, as well as the largest study, on the clinical effectiveness of T-IMRT compared with L-IMRT in conjunction with CCRT in LPC patients.
本研究采用基于人群的倾向评分（PS）匹配分析，比较断层放疗引导的调强适形放疗（以下简称T-IMRT）与直线加速器引导的调强适形放疗（以下简称L-IMRT）在临床局限性咽癌（LPC，分为鼻咽癌和非鼻咽癌）根治性同步放化疗（CCRT）中的疗效。
从台湾健康福利数据科学中心数据库的所有居民中识别出2007年至2014年间确诊的符合条件的LPC患者。根据感兴趣的协变量估计的PS构建PS匹配样本，以比较T-IMRT和L-IMRT的疗效。在初步分析中，比较总生存期（OS）以评估疗效。我们还评估了局部区域无复发生存期和咽癌特异性生存期，并进行了补充分析。
研究人群包括960例患者，平均分为两组。T-IMRT组和L-IMRT组的OS无显著差异（死亡风险比：0.82，p = 0.15，T-IMRT组和L-IMRT组的5年OS率分别为79%和74%），其他终点或补充分析也无显著差异。
对于接受根治性CCRT治疗的LPC患者，我们发现T-IMRT组和L-IMRT组在疾病控制或生存期方面无显著差异。然而，需要进一步的研究，尤其是随机试验或关注其他维度（如生活质量）的研究。知识进展：我们提供了第一项基于人群的研究，也是关于T-IMRT与L-IMRT联合CCRT治疗LPC患者临床疗效的最大规模研究。
