School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.
Cancer Institute NSW, St Leonards, Australia.
Int J Radiat Oncol Biol Phys. 2021 Oct 1;111(2):417-423. doi: 10.1016/j.ijrobp.2021.04.033. Epub 2021 May 8.
Recent evidence shows the noninferiority of hypofractionated radiation therapy regimens compared with conventional regimens in the treatment of prostate cancer (PCa). Hypofractionation has benefits for both the patient and health care system, because of the shorter treatment duration. Despite this advantage, the uptake of hypofractionation can be slow. Here we investigate the factors influencing the changing use of moderate hypofractionation (HypoRT) for the treatment of PCa.
We conducted a population-based, retrospective, consecutive cohort study using the 2014 to 2018 Outpatient Radiation Oncology Data from public and private treatment facilities in New South Wales, Australia. Included participants had a PCa diagnosis of any risk, and they completed curative-intent external beam radiation therapy without treatment to lymph nodes. Factors potentially affecting use of HypoRT were examined using a 3-level hierarchical logistic regression model. The effects were reported using adjusted, median, or interval odds ratios.
The study included 4915 patients. Of these, 4053 patients (82.5%) received conventional fractionation, and 862 patients (17.5%) received HypoRT. HypoRT utilization increased from 5.2% in 2014 to 40.3% in 2018. The treating radiation oncologist, treatment facility, and increasing distance to treatment centers had the greatest influence on HypoRT uptake. The main limitation was the lack of stratification by PCa risk categorization.
Although HypoRT uptake has considerably increased between 2014 and 2018, it remains variable among facilities and treating radiation oncologists. Strategies are being explored to reduce inter-clinician variability.
最近的证据表明，与常规治疗方案相比，前列腺癌（PCa）的分割放疗方案具有非劣效性。由于治疗时间缩短，分割放疗对患者和医疗保健系统都有好处。尽管有这个优势，但分割放疗的采用速度可能较慢。在这里，我们研究了影响中度分割放疗（HypoRT）治疗 PCa 用途变化的因素。
我们使用澳大利亚新南威尔士州公共和私人治疗机构 2014 年至 2018 年的门诊放射肿瘤学数据进行了一项基于人群的回顾性连续队列研究。纳入的参与者患有任何风险的 PCa 诊断，并且完成了治愈性意图的外照射放疗，而未对淋巴结进行治疗。使用 3 级层次逻辑回归模型检查了可能影响 HypoRT 使用的因素。使用调整后的、中位数或间隔比值比报告了影响。
该研究共纳入 4915 例患者。其中，4053 例（82.5%）患者接受常规分割放疗，862 例（17.5%）患者接受 HypoRT。2014 年 HypoRT 的使用率为 5.2%，2018 年增至 40.3%。治疗放射肿瘤学家、治疗机构和到治疗中心的距离增加对 HypoRT 的采用影响最大。主要限制是缺乏按 PCa 风险分类分层。
尽管 2014 年至 2018 年间 HypoRT 的采用率有了显著提高，但在不同的医疗机构和治疗放射肿瘤学家之间仍然存在差异。正在探索策略以减少临床医生之间的变异性。
