Cher Benjamin A Y, Dykstra Michael, Wang Chang, Schipper Matthew, Hayman James A, Mayo Charles S, Jagsi Reshma
Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan.
Department of Biostatistics, University of Michigan Medical School, Ann Arbor, Michigan.
Adv Radiat Oncol. 2022 Jul 22;7(6):101032. doi: 10.1016/j.adro.2022.101032. eCollection 2022 Nov-Dec.
Recent clinical trials suggest hypofractionated treatment regimens are appropriate for treatment of many cancers. It is important to understand and document hypofractionation adoption because of its implications for treatment center patient volumes. There is no recent U.S. study of trends in hypofractionation adoption that includes comparisons of multiple disease sites and data since the onset of COVID-19. In this context, this study describes trends in treatment fractionation at a single academic center from 2010 to 2020.
From an institutional database, records were extracted for treatment of 4 disease site categories: all cancers, breast cancer, prostate cancer, and bone metastases. For each disease site, the mean number of fractions per treatment course was reported for each year of the study period. To explore whether the COVID-19 pandemic was associated with increased hypofractionation adoption, piecewise linear regression models were used to estimate a changepoint in the time trend of mean monthly number of fractions per treatment course and to evaluate whether this changepoint coincided with pandemic onset.
The data set included 22,865 courses of radiation treatment and 375,446 treatment fractions. The mean number of fractions per treatment course for all cancers declined from 17.5 in 2010 to 13.6 in 2020. There was increased adoption of hypofractionation at this institution for all cancers and specifically for both breast and prostate cancer. For bone metastases, hypofractionation had largely been adopted before the study period. For most disease sites, adoption of hypofractionated treatment courses occurred before pandemic onset. Bone metastases was the only disease site where a pandemic-driven increase in hypofractionation adoption could not be ruled out.
This study reveals increasing use of hypofractionated regimens for a variety of cancers throughout the study period, which largely occurred before the onset of the COVID-19 pandemic at this institution.
近期临床试验表明，大分割治疗方案适用于多种癌症的治疗。了解并记录大分割治疗方案的采用情况很重要，因为这对治疗中心的患者数量有影响。近期美国尚无关于大分割治疗方案采用趋势的研究，该研究需涵盖多个疾病部位的比较以及自新冠疫情开始以来的数据。在此背景下，本研究描述了2010年至2020年期间单一学术中心的治疗分割趋势。
从机构数据库中提取了4种疾病部位类别的治疗记录：所有癌症、乳腺癌、前列腺癌和骨转移瘤。对于每个疾病部位，报告了研究期间各年份每个治疗疗程的平均分割次数。为探究新冠疫情是否与大分割治疗方案采用率的增加有关，采用分段线性回归模型来估计每个治疗疗程平均每月分割次数时间趋势的变化点，并评估该变化点是否与疫情爆发时间一致。
数据集包括22865个放射治疗疗程和375446次治疗分割。所有癌症每个治疗疗程的平均分割次数从2010年的17.5次降至2020年的13.6次。该机构所有癌症，尤其是乳腺癌和前列腺癌的大分割治疗方案采用率均有所增加。对于骨转移瘤，在研究期间之前大分割治疗方案已基本被采用。对于大多数疾病部位，大分割治疗疗程的采用发生在疫情爆发之前。骨转移瘤是唯一不能排除疫情导致大分割治疗方案采用率增加的疾病部位。
本研究揭示了在整个研究期间，多种癌症越来越多地使用大分割治疗方案，这在很大程度上发生在该机构新冠疫情爆发之前。
