Department of Radiation Oncology, New York Presbyterian Hospital, New York, New York, United States of America.
University of Wisconsin - Beloit Health Cancer Center, Beloit, Wisconsin, United States of America.
PLoS One. 2021 May 27;16(5):e0252053. doi: 10.1371/journal.pone.0252053. eCollection 2021.
High-frequency image-guided radiotherapy (hfIGRT) is ubiquitous but its benefits are unproven. We examined the cost effectiveness of hfIGRT in stage III non-small-cell lung cancer (NSCLC).
We selected stage III NSCLC patients ≥66 years old who received definitive radiation therapy from the Surveillance, Epidemiology, and End-Results-Medicare database. Patients were stratified by use of hfIGRT using Medicare claims. Predictors for hfIGRT were calculated using a logistic model. The impact of hfIGRT on lung toxicity free survival (LTFS), esophageal toxicity free survival (ETFS), cancer-specific survival (CSS), overall survival (OS), and cost of treatment was calculated using Cox regressions, propensity score matching, and bootstrap methods.
Of the 4,430 patients in our cohort, 963 (22%) received hfIGRT and 3,468 (78%) did not. By 2011, 49% of patients were receiving hfIGRT. Predictors of hfIGRT use included treatment with intensity-modulated radiotherapy (IMRT) (OR = 7.5, p < 0.01), recent diagnosis (OR = 51 in 2011 versus 2006, p < 0.01), and residence in regions where the Medicare intermediary allowed IMRT (OR = 1.50, p < 0.01). hfIGRT had no impact on LTFS (HR 0.97; 95% CI 0.86-1.09), ETFS (HR 1.05; 95% CI 0.93-1.18), CSS (HR 0.94; 95% CI 0.84-1.04), or OS (HR 0.95; 95% CI 0.87-1.04). Mean radiotherapy and total medical costs six months after diagnosis were $17,330 versus $15,024 (p < 0.01) and $71,569 versus $69,693 (p = 0.49), respectively.
hfIGRT did not affect clinical outcomes in elderly patients with stage III NSCLC but did increase radiation cost. hfIGRT deserves further scrutiny through a randomized controlled trial.
高频图像引导放疗（hfIGRT）已广泛应用，但尚未证实其具有获益。我们研究了 hfIGRT 在 III 期非小细胞肺癌（NSCLC）中的成本效益。
我们从监测、流行病学和最终结果-医疗保险数据库中选择了年龄≥66 岁接受根治性放疗的 III 期 NSCLC 患者。使用医疗保险索赔对患者进行 hfIGRT 分层。使用逻辑模型计算 hfIGRT 的预测因素。使用 Cox 回归、倾向评分匹配和自举方法计算 hfIGRT 对肺毒性无进展生存率（LTFS）、食管毒性无进展生存率（ETFS）、癌症特异性生存率（CSS）、总生存率（OS）和治疗费用的影响。
在我们的队列中，4430 名患者中有 963 名（22%）接受了 hfIGRT，3468 名（78%）未接受。到 2011 年，49%的患者接受了 hfIGRT。hfIGRT 使用的预测因素包括使用调强放疗（IMRT）（OR=7.5，p<0.01）、最近诊断（OR=2011 年与 2006 年相比为 51，p<0.01）和居住在医疗保险中介允许使用 IMRT 的地区（OR=1.50，p<0.01）。hfIGRT 对 LTFS（HR0.97；95%CI0.86-1.09）、ETFS（HR1.05；95%CI0.93-1.18）、CSS（HR0.94；95%CI0.84-1.04）或 OS（HR0.95；95%CI0.87-1.04）无影响。诊断后 6 个月的平均放疗和总医疗费用分别为 17330 美元和 15024 美元（p<0.01）和 71569 美元和 69693 美元（p=0.49）。
hfIGRT 并未影响老年 III 期 NSCLC 患者的临床结局，但增加了放疗费用。hfIGRT 值得通过随机对照试验进一步研究。
