Department of Radiation Oncology, Weill Cornell Medicine, New York, New York.
Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York.
JAMA Netw Open. 2020 Feb 5;3(2):e1920471. doi: 10.1001/jamanetworkopen.2019.20471.
Stereotactic body radiotherapy is a hypofractionated, cost-effective treatment option for localized prostate cancer.
To characterize US national trends and the clinical and socioeconomic factors associated with the use of stereotactic body radiotherapy in prostate cancer.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data collected by the National Cancer Database to assess the clinical and socioeconomic factors among 106 926 men diagnosed as having prostate cancer from 2010 to 2015 who underwent definitive radiotherapy and the trends in the use of this therapy. The initial analysis was performed between January and February 2018, with final updates performed August 2019.
Stereotactic body radiotherapy, defined as 5 fractions of radiotherapy.
Temporal trends and clinical and sociodemographic factors associated with stereotactic body radiotherapy use.
In total, 106 926 patients diagnosed as having localized prostate cancer between 2010 and 2015 and receiving definitive radiotherapy were identified. White patients composed 77.3% of this cohort, whereas black patients composed 18.7%. Government-issued insurance was used by 61.2% of patients. More than 80% of patients had a Charlson-Deyo Comorbidity Index score of 0 (range, 0 to ≥3, with lower numbers indicating fewer comorbidities). In the study population, 25.7% had low-risk disease; 26.3%, favorable intermediate-risk disease; 23.3%, unfavorable intermediate-risk disease; and 24.7%, high-risk disease. The proportion of patients who underwent radiotherapy and received stereotactic body radiotherapy (a total of 5395 patients) increased from 3.1% in 2010 to 7.2% in 2015 (odds ratio, 0.36; 95% CI, 0.33-0.40; P < .001). Among the entire cohort, patients received a median dose of 36.25 Gy (range, 30.00-50.00 Gy). Androgen deprivation therapy use increased significantly as disease risk level increased among all patients receiving radiotherapy (9.5% with low risk to 76.6% with high risk; P = .02) and among those receiving stereotactic body radiotherapy (4.1% with low risk to 33.2% with high risk; P = .04) or not receiving stereotactic body radiotherapy (9.9% with low risk to 77.6% with high risk; P = .04). Patients treated at an academic center, living in an urban area, or possessing higher incomes and those who were healthier, white individuals, or were diagnosed as having lower-risk prostate cancer had higher odds of receiving stereotactic body radiotherapy.
This study found that stereotactic body radiotherapy use in prostate cancer more than doubled from 2010 to 2015 but accounted for less than 10% of all patients undergoing radiotherapy. Androgen deprivation therapy use increased with disease risk among patients overall, regardless of receiving stereotactic body radiotherapy. Socioeconomic and clinical determinants of stereotactic body radiotherapy included risk category, Charlson-Deyo Comorbidity Index score, facility type and location, income, race/ethnicity, and year of diagnosis. These results are hypothesis generating; further studies evaluating potential disparities in stereotactic body radiotherapy use in localized prostate cancer are warranted.
立体定向体部放射治疗是一种低分割、具有成本效益的局部前列腺癌治疗选择。
描述美国全国范围内的趋势以及与立体定向体部放射治疗在前列腺癌中的应用相关的临床和社会经济因素。
设计、地点和参与者：本回顾性队列研究使用国家癌症数据库收集的数据，评估了 2010 年至 2015 年间被诊断为患有局限性前列腺癌并接受根治性放疗的 106926 名男性的临床和社会经济因素以及这种治疗方法的应用趋势。初始分析于 2018 年 1 月至 2 月之间进行，最终更新于 2019 年 8 月进行。
立体定向体部放疗，定义为 5 个放射治疗剂量。
与立体定向体部放疗使用相关的时间趋势和临床及社会人口统计学因素。
共确定了 106926 名 2010 年至 2015 年间被诊断为患有局限性前列腺癌并接受根治性放疗的患者。队列中，白人患者占 77.3%，黑人患者占 18.7%。61.2%的患者使用政府发放的保险。超过 80%的患者的 Charlson-Deyo 合并症指数评分为 0（范围为 0 至≥3，分数越低表示合并症越少）。在研究人群中，25.7%的患者为低危疾病；26.3%为中危有利疾病；23.3%为中危不利疾病；24.7%为高危疾病。接受放疗并接受立体定向体部放疗的患者比例（共 5395 例）从 2010 年的 3.1%增加到 2015 年的 7.2%（比值比，0.36；95%置信区间，0.33-0.40；P<0.001）。在整个队列中，患者接受的中位数剂量为 36.25 Gy（范围，30.00-50.00 Gy）。在所有接受放疗的患者（低危患者的雄激素剥夺治疗使用率为 9.5%，高危患者的为 76.6%；P=0.02）和接受立体定向体部放疗的患者（低危患者的为 4.1%，高危患者的为 33.2%；P=0.04）或未接受立体定向体部放疗的患者（低危患者的为 9.9%，高危患者的为 77.6%；P=0.04）中，随着疾病风险水平的升高，雄激素剥夺治疗的使用率显著增加。在学术中心接受治疗、居住在城市地区、收入较高、身体更健康、为白人或被诊断为患有低危前列腺癌的患者，更有可能接受立体定向体部放疗。
本研究发现，2010 年至 2015 年间，前列腺癌中立体定向体部放疗的使用率增加了一倍以上，但在接受放疗的所有患者中，立体定向体部放疗的比例不到 10%。无论是否接受立体定向体部放疗，患者的整体疾病风险越高，雄激素剥夺治疗的使用率越高。立体定向体部放疗的社会经济和临床决定因素包括风险类别、Charlson-Deyo 合并症指数评分、机构类型和位置、收入、种族/民族和诊断年份。这些结果只是初步的假设，需要进一步研究评估在局部前列腺癌中立体定向体部放疗应用的潜在差异。
