Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America.
Department of Otolaryngology-Head and Neck Surgery, Mass. Eye and Ear, Mass. General Hospital, Boston Medical Center, United States of America; Harvard Medical School, United States of America.
Am J Otolaryngol. 2021 May-Jun;42(3):102913. doi: 10.1016/j.amjoto.2021.102913. Epub 2021 Jan 12.
To evaluate demographic, clinicopathological, treatment factors including biological effective radiation dose (BED) that influence overall survival in head and neck cancer (HNC) patients treated with stereotactic body radiation therapy (SBRT).
Between 2004 and 2015, 591 SBRT-treated HNC patients were identified from the National Cancer Data Base. A BED using an alpha/beta ratio of 10 (BED), was used to compare dose fractionation of different SBRT regimens. Overall survival was estimated using the Kaplan Meier method, and log-rank tests were used to determine statistical significance. Cox regression modeling was used to compute crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI).
Median follow-up was 11.9 (interquartile range, 5.5 to 26.7) months. The 5-year overall survival rate was 15.5%. On multivariate analysis, older age, Charlson-Deyo comorbidity score ≥ 1, history of cancer, tumor, nodal and metastatic stage, and receiving treatment at academic/research program were associated with poor survival. Compared to SBRT alone, superior survival was observed with SBRT with chemotherapy, surgery with SBRT, but not surgery with SBRT and chemotherapy. Improved survival was observed with aa BED of ≥59.5 Gy (adjusted HR 0.57, 95% CI 0.46-0.70, P < 0.0001).
Factors affecting associated with worse survival in HNC patients treated with SBRT included older age, patient comorbidities, advanced tumor stage, cancer history, and lower biological effective SBRT dose.
2b (individual cohort study).
评估人口统计学、临床病理学、治疗因素，包括影响立体定向体部放射治疗（SBRT）治疗的头颈部癌症（HNC）患者总生存率的生物有效辐射剂量（BED）。
2004 年至 2015 年间，从国家癌症数据库中确定了 591 例接受 SBRT 治疗的 HNC 患者。采用α/β比为 10（BED）的 BED 来比较不同 SBRT 方案的剂量分割。使用 Kaplan-Meier 法估计总生存率，并使用对数秩检验确定统计学意义。使用 Cox 回归模型计算粗风险比（HR）和 95%置信区间（CI）。
中位随访时间为 11.9 个月（四分位距 5.5 至 26.7）。5 年总生存率为 15.5%。多因素分析显示，年龄较大、Charlson-Deyo 合并症评分≥1、癌症史、肿瘤、淋巴结和转移分期以及在学术/研究项目中接受治疗与生存率较差相关。与单纯 SBRT 相比，SBRT 联合化疗、SBRT 联合手术的生存率更高，但 SBRT 联合手术和化疗的生存率没有提高。BED 大于等于 59.5Gy 时观察到生存率改善（调整 HR 0.57，95%CI 0.46-0.70，P<0.0001）。
影响 SBRT 治疗的 HNC 患者生存的因素包括年龄较大、患者合并症、晚期肿瘤分期、癌症史和较低的 SBRT 生物有效剂量。
2b（个体队列研究）。
