Lin Steven H, Liao Kaiping, Lei Xiudong, Verma Vivek, Shaaban Sherif, Lee Percy, Chen Aileen B, Koong Albert C, Hoftstetter Wayne L, Frank Steven J, Liao Zhongxing, Shih Ya-Chen Tina, Giordano Sharon H, Smith Grace L
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Int J Part Ther. 2022 Jun 23;9(1):18-27. doi: 10.14338/IJPT-22-00001.1. eCollection 2022 Summer.
In patients treated with chemoradiation for esophageal cancer (EC), randomized trial data demonstrate that proton beam therapy (PBT) reduces toxicities and postoperative complications (POCs) compared with intensity-modulated radiation therapy (IMRT). However, whether radiation therapy modality affects postoperative health care resource utilization remains unknown.
We examined 287 patients with EC who received chemoradiation (prescribed 50.4 Gy/GyE) followed by esophagectomy, including a real-world observational cohort of 237 consecutive patients treated from 2007 to 2013 with PBT (n = 81) versus IMRT (n = 156); and an independent, contemporary comparison cohort of 50 patients from a randomized trial treated from 2012 to 2019 with PBT (n = 21) versus IMRT (n = 29). Postoperative complications were abstracted from medical records. Health care charges were obtained from institutional claims and adjusted for inflation (2021 dollars). Charge differences (Δ = $PBT - $IMRT) were compared by treatment using adjusted generalized linear models with the gamma distribution.
Baseline PBT versus IMRT characteristics were not significantly different. In the observational cohort, during the neoadjuvant chemoradiation phase, health care charges were higher for PBT versus IMRT (Δ = +$71,959; 95% confidence interval [CI], $62,274-$82,138; < .001). There was no difference in surgical charges (Δ = -$2234; 95% CI, -$6003 to $1695; = .26). However, during postoperative hospitalization following esophagectomy, health care charges were lower for PBT versus IMRT (Δ = -$25,115; 95% CI, -$37,625 to -$9776; = .003). In the comparison cohort, findings were analogous: Charges were higher for PBT versus IMRT during chemoradiation (Δ = +$61,818; 95% CI, $49,435-$75,069; < .001), not different for surgery (Δ = -$4784; 95% CI, -$6439 to $3487; = .25), and lower for PBT postoperatively (Δ = -$27,048; 95% CI, -$41,974 to -$5300; = .02). Lower postoperative charges for PBT were especially seen among patients with any POCs in the contemporary comparison (Δ = -$176,448; 95% CI, -$209,782 to -$78,813; = .02).
Higher up-front chemoradiation resource utilization for PBT in patients with EC was partially offset postoperatively, moderated by reduction in POC risks. Results extend existing clinical evidence of toxicity reduction with PBT.
在接受食管癌（EC）放化疗的患者中，随机试验数据表明，与调强放射治疗（IMRT）相比，质子束治疗（PBT）可降低毒性和术后并发症（POC）。然而，放射治疗方式是否会影响术后医疗资源的利用仍不清楚。
我们研究了287例接受放化疗（处方剂量为50.4 Gy/GyE）后行食管切除术的EC患者，包括一个真实世界观察队列，该队列由2007年至2013年连续接受PBT（n = 81）与IMRT（n = 156）治疗的237例患者组成；以及一个独立的当代对照队列，该队列由2012年至2019年一项随机试验中接受PBT（n = 21）与IMRT（n = 29）治疗的50例患者组成。术后并发症从医疗记录中提取。医疗费用从机构索赔中获取，并根据通货膨胀进行调整（2021年美元）。使用具有伽马分布的调整广义线性模型，通过治疗比较费用差异（Δ = PBT组费用 - IMRT组费用）。
PBT组与IMRT组的基线特征无显著差异。在观察队列中，在新辅助放化疗阶段，PBT组的医疗费用高于IMRT组（Δ = +71,959美元；95%置信区间[CI]，62,274 - 82,138美元；P <.001）。手术费用无差异（Δ = -2234美元；95% CI，-6003至1695美元；P =.26）。然而在食管切除术后住院期间，PBT组的医疗费用低于IMRT组（Δ = -25,115美元；95% CI，-37,625至-9776美元；P =.003）。在对照队列中，结果类似：放化疗期间PBT组费用高于IMRT组（Δ = +61,818美元；95% CI，49,435 - 75,069美元；P <.001），手术费用无差异（Δ = -4784美元；95% CI，-6439至3487美元；P =.25），术后PBT组费用较低（Δ = -27,048美元；95% CI，-41,974至-5300美元；P =.02）。在当代对照中，PBT组术后费用较低在有任何POC的患者中尤为明显（Δ = -176,448美元；95% CI，-209,782至-78,813美元；P =.02）。
EC患者中PBT较高的前期放化疗资源利用在术后被部分抵消，因POC风险降低而得到缓解。结果扩展了PBT降低毒性的现有临床证据。
