Liu Sean M, Brooks Eric D, Rubin M Laura, Grosshans David R, Frank Steven J, McAleer Mary Frances, McGovern Susan L, Paulino Arnold C, Woodhouse Kristina D
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Int J Part Ther. 2020 Dec 31;7(3):1-10. doi: 10.14338/IJPT-20-00038.1. eCollection 2021 Winter.
Patient travel time can cause treatment delays when providers and families decide to seek proton therapy. We examined whether travel distance or referral pattern (domestic versus international) affects time to radiation therapy and subsequent disease outcomes in patients with medulloblastoma at a large academic proton center.
Children with medulloblastoma treated at MD Anderson (MDA) with a protocol of proton beam therapy (PBT) between January 4, 2007, and June 25, 2014, were included in the analysis. The Wilcoxon rank-sum test was used to study the association between time to start of radiation and distance. Classification- and regression-tree analyses were used to explore binary thresholds for continuous covariates (ie, distance). Failure-free survival was defined as the time interval between end of radiation and failure or death.
96 patients were included in the analysis: 17 were international (18%); 19 (20%) were from Houston, Texas; 21 were from other cities inside Texas (21%); and 39 (41%) were from other US states. The median time from surgery to start of radiation was not significantly different for international patients (median = 1.45 months) compared with US patients (median = 1.15 months; = .13). However, time from surgery to start of radiation was significantly longer for patients residing > 1716 km (> 1066 miles) from MDA (median = 1.31 months) than for patients residing ≤ 1716 km (≤ 1066 miles) from MDA (median = 1.05 months; = .01). This 1- to 2-week delay (median = 7.8 days) did not affect failure-free survival (hazard ratio = 1.34; = .43).
We found that short delays in proton access can exist for patients traveling long distances to proton centers. However, in this study, treatment delays did not affect outcomes. This highlights the appropriateness of PBT in the face of travel coordination. Investment by proton centers in a rigorous intake process is justified to offer timely access to curative PBT.
当医疗服务提供者和患者家属决定寻求质子治疗时，患者的行程时间可能会导致治疗延误。我们研究了在一家大型学术质子中心，行程距离或转诊模式（国内与国际）是否会影响髓母细胞瘤患者开始放射治疗的时间及后续疾病转归。
分析纳入了2007年1月4日至2014年6月25日期间在MD安德森癌症中心（MDA）按照质子束治疗（PBT）方案接受治疗的髓母细胞瘤患儿。采用Wilcoxon秩和检验研究开始放疗时间与距离之间的关联。使用分类与回归树分析来探索连续协变量（即距离）的二元阈值。无失败生存定义为放疗结束至失败或死亡的时间间隔。
96例患者纳入分析：17例为国际患者（18%）；19例（20%）来自德克萨斯州休斯顿；21例（21%）来自德克萨斯州内其他城市；39例（41%）来自美国其他州。国际患者从手术到开始放疗的中位时间（中位值 = 1.45个月）与美国患者（中位值 = 1.15个月；P = 0.13）相比无显著差异。然而，居住在距离MDA大于1716公里（大于1066英里）的患者从手术到开始放疗的时间（中位值 = 1.31个月）显著长于居住在距离MDA小于等于1716公里（小于等于1066英里）的患者（中位值 = 1.05个月；P = 0.01）。这1至2周的延迟（中位值 = 7.8天）并未影响无失败生存（风险比 = 1.34；P = 0.43）。
我们发现，长途前往质子中心的患者可能会出现质子治疗延迟的情况。然而，在本研究中，治疗延迟并未影响治疗效果。这凸显了在面对行程协调问题时质子束治疗的适用性。质子中心在严格的收治流程上进行投入是合理的，以便及时提供根治性质子束治疗。
