Jhaveri Jaymin, Cheng En, Tian Sibo, Buchwald Zachary, Chowdhary Mudit, Liu Yuan, Gillespie Theresa W, Olson Jeffrey J, Diaz Aidnag Z, Voloschin Alfredo, Eaton Bree R, Crocker Ian R, McDonald Mark W, Curran Walter J, Patel Kirtesh R
Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, United States.
Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, United States.
Front Oncol. 2018 Nov 28;8:440. doi: 10.3389/fonc.2018.00440. eCollection 2018.
To investigate the impact of proton radiotherapy (PBT) on overall survival (OS) and evaluate PBT usage trends for patients with gliomas in the National Cancer Data Base (NCDB). Patients with a diagnosis of World Health Organization (WHO) Grade I-IV glioma treated with definitive radiation therapy (RT) between the years of 2004-13 were identified. Patients were stratified based on WHO Grade and photon radiotherapy (XRT) vs. PBT. Univariate (UVA) and multivariable analysis (MVA) with OS were performed by Cox proportional hazards model and log-rank tests. Propensity score (PS) weighting was utilized to account for differences in patient characteristics and to minimize selection bias. There were a total of 49,405 patients treated with XRT and 170 patients treated with PBT. Median follow-up time was 62.1 months. On MVA, the following factors were associated with receipt of PBT (all < 0.05): WHO Grade I-II gliomas, treatment at an academic/research program, west geographic facility location, and surgical resection. After PS weighting, all patients treated with PBT were found to have superior median and 5 year survival than patients treated with XRT: 45.9 vs. 29.7 months ( = 0.009) and 46.1 vs. 35.5% ( = 0.0160), respectively. PBT is associated with improved OS compared to XRT for patients with gliomas. This finding warrants verification in the randomized trial setting in order to account for potential patient imbalances not adequately captured by the NCDB, such as tumor molecular characteristics and patient performance status. This is the first study that compares the outcomes of patients treated with photon based radiotherapy vs. proton based radiotherapy for patients with gliomas. In this retrospective analysis, the results demonstrate that proton therapy is associated with improved outcomes which support ongoing prospective, randomized clinical trials comparing the two modalities in patients with gliomas.
在国家癌症数据库(NCDB)中,研究质子放疗(PBT)对总体生存期(OS)的影响,并评估胶质细胞瘤患者使用PBT的趋势。确定2004年至2013年间接受确定性放射治疗(RT)的世界卫生组织(WHO)I-IV级胶质细胞瘤患者。根据WHO分级以及光子放疗(XRT)与PBT对患者进行分层。通过Cox比例风险模型和对数秩检验对OS进行单变量(UVA)和多变量分析(MVA)。利用倾向评分(PS)加权来解释患者特征的差异并尽量减少选择偏倚。共有49405例患者接受了XRT治疗,170例患者接受了PBT治疗。中位随访时间为62.1个月。在MVA中,以下因素与接受PBT相关(均P<0.05):WHO I-II级胶质细胞瘤、在学术/研究机构接受治疗、西部地理区域的医疗机构以及手术切除。经过PS加权后,发现所有接受PBT治疗的患者的中位生存期和5年生存率均优于接受XRT治疗的患者:分别为45.9个月对29.7个月(P=0.009)和46.1%对35.5%(P=0.0160)。与XRT相比,PBT与胶质细胞瘤患者的OS改善相关。这一发现需要在随机试验中进行验证,以解释NCDB未充分捕捉到的潜在患者失衡情况,如肿瘤分子特征和患者体能状态。这是第一项比较胶质细胞瘤患者接受基于光子的放疗与基于质子的放疗的结果的研究。在这项回顾性分析中,结果表明质子治疗与改善的结果相关,这支持了正在进行的比较这两种治疗方式的前瞻性、随机临床试验。