澳大利亚新南威尔士州脑转移瘤患者姑息性放疗分割模式。
Patterns of palliative radiotherapy fractionation for brain metastases patients in New South Wales, Australia.
机构信息
Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia; Department of Radiation Oncology, South Western Sydney Local Health District, New South Wales, Australia.
Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Australia.
出版信息
Radiother Oncol. 2021 Mar;156:174-180. doi: 10.1016/j.radonc.2020.12.020. Epub 2020 Dec 24.
BACKGROUND AND PURPOSE
There is a paucity of studies examining variation in the use of palliative radiation therapy (RT) fractionation for brain metastases. The aim of this study is to assess variation in palliative RT fractionation given for brain metastases in New South Wales (NSW), Australia, and identify factors associated with variation.
MATERIALS AND METHODS
This is a population-based cohort of patients who received whole brain RT (WBRT) for brain metastases (2009-2014), as captured in the NSW Central Cancer Registry. A logistic regression model was used to identify factors associated with fractionation type.
RESULTS
Of the 2,698 patients that received WBRT, 1,389 courses (51%) were < 6 fractions, 1,050 courses (39%) were 6-10 fractions, and 259 courses (10%) were > 10 fractions. Older patients were more likely to be treated with shorter courses (P < 0.0001). Patients with primary lung cancers were more likely to receive shorter courses compared with other primary cancers (P < 0.0001). Patients without surgical excision were more likely to receive < 6 fractions compared to those who underwent surgical excision. Shorter courses were more likely to be delivered to patients with the most disadvantaged socioeconomic status (SES) compared with patients with the least disadvantaged SES (P < 0.0001). There were significant fluctuations in the proportion of courses using lower number of fractions over time from 2009 to 2014, but no apparent trend (P = 0.02). There was wide variation in the proportion of shorter courses across residence local health districts, ranging from 24% to 69% for < 6 fractions, 21% to 72% for 6-10 fractions, and 4% to 20% for > 10 fractions (P < 0.0001).
CONCLUSION
This study has identified significant unwarranted variations in fractionation for WBRT in NSW. Accelerating the uptake of shorter fractionation regimens, if warranted through evidence, should be prioritised to enhance evidence-based care.
背景与目的
目前，关于脑转移瘤姑息性放射治疗（palliative radiation therapy，RT）分割方案应用的变化，研究相对较少。本研究旨在评估澳大利亚新南威尔士州（New South Wales，NSW）脑转移瘤姑息性 RT 分割方案的变化，并确定其变化的相关因素。
材料与方法
本研究是基于人群的脑转移瘤患者全脑放疗（Whole brain RT，WBRT）队列，数据来源于 NSW 中央癌症登记处（Central Cancer Registry）。采用逻辑回归模型来确定与分割类型相关的因素。
结果
在 2698 例接受 WBRT 的患者中，1389 例（51%）接受的分割方案为<6 个分割野，1050 例（39%）为 6-10 个分割野，259 例（10%）为>10 个分割野。年龄较大的患者更有可能接受较短的分割方案（P<0.0001）。与其他原发性癌症相比，原发性肺癌患者更有可能接受较短的分割方案（P<0.0001）。未行手术切除的患者比接受手术切除的患者更有可能接受<6 个分割野的方案。与社会经济地位（socioeconomic status，SES）最低的患者相比，SES 最低的患者更有可能接受较短的分割方案（P<0.0001）。从 2009 年到 2014 年，接受较少分割野的方案比例随时间发生了显著波动，但无明显趋势（P=0.02）。在各地区接受较短分割野的比例差异很大，范围为<6 个分割野的 24%-69%，6-10 个分割野的 21%-72%，>10 个分割野的 4%-20%（P<0.0001）。
结论
本研究发现，在 NSW 地区，WBRT 的分割方案存在显著的不必要差异。如果有证据表明缩短分割方案是合理的，应优先考虑加速其应用，以提高循证护理水平。
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