Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2021 Apr 1;109(5):1279-1285. doi: 10.1016/j.ijrobp.2020.11.064. Epub 2020 Dec 1.
Treatment noncompletion may occur with radiation therapy (RT), especially with protracted treatment courses such as RT for prostate cancer, and may affect the efficacy of RT. For men with localized prostate cancer managed with primary RT, we evaluated associations between rates of treatment noncompletion and RT fractionation schedules.
The National Cancer Database identified men diagnosed from 2004 to 2014 treated with primary RT. Patients receiving 180 cGy/fraction or 200 cGy/fraction were defined as having completed radiation therapy if they received ≥41 fractions of 180 cGy/fraction or ≥37 fractions of 200 cGy/fraction. Stereotactic body radiation therapy (SBRT) was defined as 5 to 8 fractions of 600 to 800 cGy/fraction. Odds ratios compared rates of treatment noncompletion, adjusting for sociodemographic covariates. A propensity-adjusted multivariable Cox regression assessed the association between treatment completion and overall survival.
Of 157,657 patients, 95.7% (n = 150,847) received conventional fractionation and 4.3% (n = 6810) received SBRT. Rates of noncompletion were 12.5% (n = 18,803) among patients who received conventional fractionation and 1.9% (n = 131) among patients who received SBRT (odds ratio [OR] versus conventional, 0.21; 95% confidence interval [CI], 0.18-0.26; P < .001). The rate of noncompletion among 25,727 African American patients was 12.8%, compared with 11.8% among 126,199 white patients (OR, 1.14; 95% CI, 1.09-1.19; P < .001). In a subgroup analysis, the disparity in noncompletion persisted for conventional fractionation (13.2% vs 12.3%, respectively; OR, 1.09; 95% CI, 1.05-1.13; P < .001), but not for SBRT (2.2% vs 1.8%, respectively; OR, 1.26; 95% CI, 0.79-2.00; P = .34). Noncompletion was associated with worse survival in a propensity-adjusted multivariable analysis (hazard ratio, 1.25; 95% CI, 1.22-1.29; P < .001).
SBRT was associated with lower rates of RT noncompletion among men with localized prostate cancer. African American race was associated with greater rates of treatment noncompletion, although the disparity may be decreased among men receiving SBRT.
放射治疗（RT）过程中可能会出现治疗不完成的情况，尤其是对于前列腺癌等疗程较长的情况，这可能会影响 RT 的疗效。对于接受原发 RT 治疗的局限性前列腺癌患者，我们评估了治疗不完成率与 RT 分割方案之间的关系。
国家癌症数据库确定了 2004 年至 2014 年期间接受原发 RT 治疗的男性患者。接受 180 cGy/分次或 200 cGy/分次的患者，如果接受了≥41 次 180 cGy/分次或≥37 次 200 cGy/分次的照射，则被定义为完成了放射治疗。立体定向体部放射治疗（SBRT）定义为 5-8 次 600-800 cGy/分次。使用 sociodemographic 协变量调整比值比（OR）比较治疗不完成率。通过倾向调整的多变量 Cox 回归评估治疗完成与总生存之间的关联。
在 157657 例患者中，95.7%（n=150847）接受常规分割治疗，4.3%（n=6810）接受 SBRT。接受常规分割治疗的患者中，治疗不完成率为 12.5%（n=18803），接受 SBRT 的患者中为 1.9%（n=131）（OR 为 0.21；95%置信区间[CI]，0.18-0.26；P<0.001）。25727 例非裔美国患者的治疗不完成率为 12.8%，而 126199 例白人患者的治疗不完成率为 11.8%（OR 为 1.14；95%CI，1.09-1.19；P<0.001）。在亚组分析中，常规分割治疗的不完成率差异仍然存在（分别为 13.2%和 12.3%；OR 为 1.09；95%CI，1.05-1.13；P<0.001），但 SBRT 则不然（分别为 2.2%和 1.8%；OR 为 1.26；95%CI，0.79-2.00；P=0.34）。在倾向调整的多变量分析中，治疗不完成与生存结局较差相关（风险比，1.25；95%CI，1.22-1.29；P<0.001）。
SBRT 与局限性前列腺癌男性患者的 RT 治疗不完成率较低相关。非裔美国人的种族与更高的治疗不完成率相关，尽管在接受 SBRT 的患者中，这种差异可能会减少。
