currently a medical student at Weill Cornell Medicine, New York, New York.
New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, New York.
JAMA Netw Open. 2023 Oct 2;6(10):e2337165. doi: 10.1001/jamanetworkopen.2023.37165.
Technical advances in treatment of prostate cancer and a better understanding of prostate cancer biology have allowed for hypofractionated treatment courses using a higher dose per fraction. Use of ultrahypofractionated stereotactic body radiotherapy (SBRT) has also been characterized.
To characterize US national trends of different RT fractionation schemes across risk groups of prostate cancer.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data collected by the National Cancer Database (NCDB) to characterize the fractionation regimens used for 302 035 patients diagnosed as having prostate cancer from January 1, 2004, to December 31, 2020, who underwent definitive RT. The analysis was performed between February 1 and April 30, 2023.
Stereotactic body RT or ultrahypofractionation, defined as 5 or fewer fractions of external beam RT (EBRT), moderate hypofractionation, defined as 20 to 28 fractions of EBRT, or conventional fractionation, defined as all remaining EBRT fractionation schemes.
Temporal trends and clinical and sociodemographic factors associated with SBRT, moderate hypofractionation, and conventional fractionation use.
A total of 302 035 men receiving EBRT for localized prostate cancer between 2004 and 2020 were identified (40.1% aged 60-69 years). Black patients comprised 17.6% of this cohort; White patients, 77.9%; and other races and ethnicities, 4.5%. Patients with low-risk disease comprised 17.5% of the cohort; favorable intermediate-risk disease, 23.5%; unfavorable intermediate-risk disease, 23.9%; and high-risk disease, 35.1%. Treatment consisted of conventional fractionation for 81.2%, moderate hypofractionation for 12.9%, and SBRT for 6.0%. The rate of increase over time in patients receiving SBRT compared with conventional fractionation was higher (adjusted odds ratio [AOR] for 2005 vs 2004, 3.18 [95% CI, 2.04-4.94; P < .001]; AOR for 2020 vs 2004, 264.69 [95% CI, 179.33-390.68; P < .001]) than the rate of increase in patients receiving moderate hypofractionation compared with conventional fractionation (AOR for 2005 vs 2004, 1.05 [95% CI, 0.98-1.12; P = .19]; AOR for 2020 vs 2004, 4.41 [95% CI, 4.15-4.69; P < .001]). Compared with White patients, Black patients were less likely to receive SBRT compared with conventional fractionation or moderate hypofractionation (AOR for conventional fractionation, 0.84 [95% CI, 0.80-0.89; P < .001]; AOR for moderate hypofractionation, 0.77 [95% CI, 0.72-0.81; P < .001]). Compared with 2019, patients treated with all fractionation regimens declined in 2020 by 24.4%.
In this hospital-based cohort study of patients with prostate cancer treated with definitive EBRT, use of moderate hypofractionation and SBRT regimens for definitive prostate cancer treatment has increased from 2004 to 2020. Despite this increasing trend, findings suggest potential health care disparities for Black patients receiving EBRT for localized prostate cancer. The number of patients treated with EBRT in the year 2020 decreased, coinciding with official onset of the COVID-19 pandemic in March 2020.
前列腺癌治疗技术的进步和对前列腺癌生物学的更好理解，使得使用更高的单次剂量进行低分割治疗成为可能。超分割立体定向体放射治疗（SBRT）的应用也得到了描述。
描述美国不同前列腺癌风险组患者接受不同放射治疗分割方案的全国趋势。
设计、设置和参与者：这项回顾性队列研究使用国家癌症数据库（NCDB）的数据，对 2004 年 1 月 1 日至 2020 年 12 月 31 日期间接受根治性放射治疗的 302035 名被诊断为患有前列腺癌的患者进行了分析，这些患者接受了立体定向体放射治疗或超分割治疗，定义为 5 次或更少次数的外束放射治疗（EBRT）、中度低分割治疗，定义为 20 至 28 次 EBRT 或常规分割治疗，定义为所有剩余的 EBRT 分割方案。
立体定向体放射治疗或超分割治疗，定义为 5 次或更少次数的外束放射治疗（EBRT）、中度低分割治疗，定义为 20 至 28 次 EBRT 或常规分割治疗，定义为所有剩余的 EBRT 分割方案。
描述 SBRT、中度低分割和常规分割治疗使用的时间趋势以及与临床和社会人口统计学因素的关联。
共确定了 302035 名接受 EBRT 治疗局限性前列腺癌的男性患者（40.1%年龄为 60-69 岁）。该队列中黑人患者占 17.6%；白人患者占 77.9%；其他种族和族裔占 4.5%。低危疾病患者占队列的 17.5%；低危疾病患者占 23.5%；高危疾病患者占 23.9%；高危疾病患者占 35.1%。治疗包括常规分割治疗 81.2%、中度低分割治疗 12.9%和 SBRT 治疗 6.0%。与常规分割治疗相比，接受 SBRT 治疗的患者比例随时间的增加速度更高（2005 年 vs 2004 年的调整优势比 [AOR]，3.18[95%CI，2.04-4.94；P < .001]；2020 年 vs 2004 年的 AOR，264.69[95%CI，179.33-390.68；P < .001]），而与常规分割治疗相比，接受中度低分割治疗的患者比例增加速度更高（2005 年 vs 2004 年的 AOR，1.05[95%CI，0.98-1.12；P = .19]；2020 年 vs 2004 年的 AOR，4.41[95%CI，4.15-4.69；P < .001]）。与白人患者相比，黑人患者接受 SBRT 治疗而不是常规分割或中度低分割治疗的可能性较低（常规分割治疗的 AOR，0.84[95%CI，0.80-0.89；P < .001]；中度低分割治疗的 AOR，0.77[95%CI，0.72-0.81；P < .001]）。与 2019 年相比，2020 年接受所有分割方案治疗的患者下降了 24.4%。
在这项基于医院的队列研究中，对接受根治性 EBRT 治疗的前列腺癌患者进行了研究，从中度低分割和 SBRT 方案用于前列腺癌根治性治疗的使用从 2004 年增加到 2020 年。尽管呈上升趋势，但研究结果表明，接受 EBRT 治疗局限性前列腺癌的黑人患者可能存在潜在的医疗保健差异。2020 年接受 EBRT 治疗的患者数量下降，与 2020 年 3 月 COVID-19 大流行的正式开始相吻合。
