Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA.
Department of Radiation Oncology, 12250Indiana University School of Medicine, Indianapolis, IN, USA.
J Palliat Care. 2021 Apr;36(2):130-134. doi: 10.1177/0825859720982204. Epub 2020 Dec 23.
The improved survival of patients even with metastatic cancer has led to an increase in the incidence of spine metastases, suggesting the need for a more aggressive palliative treatment than conventional external beam radiation therapy (cEBRT). Consequently, spinal stereotactic body radiation therapy (SBRT) has increased in popularity over the past decade. However, there has been no comparison of patterns of usage of cEBRT versus SBRT in the treatment of spinal metastases in the US.
The National Cancer Data Base (NCDB) from 2004-2013 was used for analysis. cEBRT was defined as 30 Gy in 10 fractions, 20 Gy in 5 fractions, or 8 Gy in 1 fraction. SBRT was defined as 25-32 Gy infive5 fractions, 24-32 Gy in 4 fractions, 20-32 Gy in three fractions, 14-32 Gy in 2 fractions, or 14-24 Gy in 1 fraction. Single and multivariable associations between patient demographic and cancer characteristics and type of radiation were performed.
From 2004-2013, 23,181 patients with spinal metastases in the United States received cEBRT, while 1,030 received SBRT as part of their first course of treatment. Most patients (88%) received 10 fractions of radiation. Multivariable analysis suggested that non-Medicare or private insurance (adjusted OR 0.4-0.7), African-American race (adjusted OR = 0.8, 95%CI = 0.7-1.0), age 65+ (adjusted OR = 0.8), living in a region with lower population (adjusted OR 0.7), earlier year of diagnosis (OR = 0.9), and receiving treatment in a non-academic/research facility (adjusted OR 0.6) were associated with cEBRT. After controlling for other variables, regional education level was no longer significantly associated with cEBRT.
Most patients with spine metastases were treated with cEBRT, usually with 10 fractions. Receipt of SBRT was significantly associated with race, insurance, geography, population, type of treatment facility, and year of diagnosis, even after controlling for other factors. These findings raise questions about disparities in access to and delivery of care that deserve further investigation.
即使转移性癌症患者的生存率得到提高，脊柱转移瘤的发病率也有所增加，这表明需要比传统的外照射放射治疗（cEBRT）更积极的姑息治疗。因此，在过去十年中，脊柱立体定向体部放射治疗（SBRT）的应用越来越普及。然而，在美国，对于脊柱转移瘤的治疗，cEBRT 与 SBRT 的使用模式尚未进行比较。
本研究使用了 2004 年至 2013 年的国家癌症数据库（NCDB）进行分析。cEBRT 的定义为 30 Gy/10 次、20 Gy/5 次或 8 Gy/1 次。SBRT 的定义为 25-32 Gy/5 次、24-32 Gy/4 次、20-32 Gy/3 次、14-32 Gy/2 次或 14-24 Gy/1 次。对患者人口统计学和癌症特征与放射类型之间的单变量和多变量关联进行了分析。
2004 年至 2013 年期间，美国有 23181 例脊柱转移瘤患者接受了 cEBRT 治疗，其中 1030 例患者接受了 SBRT 作为其一线治疗的一部分。大多数患者（88%）接受了 10 次放射治疗。多变量分析表明，非医疗保险或私人保险（调整后的 OR 0.4-0.7）、非裔美国人（调整后的 OR = 0.8，95%CI = 0.7-1.0）、年龄 65 岁以上（调整后的 OR = 0.8）、居住在人口较少的地区（调整后的 OR = 0.7）、诊断年份较早（OR = 0.9）和在非学术/研究机构接受治疗（调整后的 OR = 0.6）与 cEBRT 相关。在控制其他变量后，区域教育水平与 cEBRT 不再显著相关。
大多数脊柱转移瘤患者接受 cEBRT 治疗，通常采用 10 次分割。SBRT 的应用与种族、保险、地理位置、人口、治疗机构类型和诊断年份显著相关，即使在控制其他因素后也是如此。这些发现引发了关于获得和提供护理方面的差异问题，值得进一步调查。
