Chen Meihua, Li Kexin, Gao Xuan, Ye Xia, Ju Yongjian
Department of Medical Insurance Management, Nantong First People's Hospital (Affiliated Hospital 2 of Nantong University), Nantong, Jiangsu, China.
Department of Radiotherapy, Nantong First People's Hospital (Affiliated Hospital 2 of Nantong University), Nantong, Jiangsu, China.
Front Oncol. 2025 Aug 21;15:1582201. doi: 10.3389/fonc.2025.1582201. eCollection 2025.
Non-completion of radiotherapy courses (NCRC) may happen in patients undergoing intensity-modulated radiotherapy (IMRT). Analyzing the reasons and risk factors for NCRC can lead to possible targeted measures to reduce the incidence rate. This six-year retrospective study will present a cohort analysis of NCRC from a single center.
Data from patients treated with IMRT between January 2018 and December 2023 were collected for analysis. The collected characteristics included age, gender, residential area, body mass index (BMI), tumor clinical stage, tumor type, tumor location, therapeutic intent, number of fractions, insurance status, treatment completion status, and reasons for NCRC. The radiotherapy process rigorously followed Chinese basic guidelines of quality control for radiotherapy. NCRC was defined as the failure to complete the course after starting the radiotherapy. Patients were categorized into the completion group (CG) and the non-completion group (NCG). Comprehensive analyses included six-year overall NCRC rate and annual trends, inter-group (CG vs. NCG) characteristic disparities, the reasons and risk factors for NCRC.
Among total collected 2,112 IMRT patients, the overall rate of NCRC was 5.68% (n=120), with annual values ranging 4.15-6.69% (p=0.718). The patient-driven reasons for NCRC encompassed: perceiving the final several fractions as non-essential (n=8, 6.67%); perceived insufficient therapeutic efficacy (n=34, 28.33%); financial constraints (n=3, 2.5%). The clinician-driven reasons for NCRC included: severe radiation-induced toxicities (n=39, 32.5%); disease progression (n=30, 25%); death(n=6, 5%). Significant inter-group (CG vs. NCG) differences (p<0.05) were observed in age, gender, body mass index (BMI), therapeutic intent, tumor clinical stage, tumor location, and number of fractions; however significant differences were not observed in the residential area and insurance status. Multivariate analysis revealed that the age, BMI, therapeutic intent, and tumor clinical stage were independent risk factors for NCRC (p<0.05).
Rigorous adherence to the basic guidelines of radiotherapy quality control helped maintain a stable NCRC rate (ranging 4.15%-6.69%). While 62.5% of NCRC cases were attributable to unpredictable radiation-induced toxicities, disease progression or death, the remaining 37.5% (35% due to insufficient awareness of radiotherapy and 2.5% to financial constraints) were potentially preventable. These findings underscore the need for implementing risk-stratified interventions to address modifiable barriers and reduce NCRC rates, particularly in high-risk subgroups characterized by advanced age, lower BMI, later clinical tumor stage, and palliative radiotherapy intent.
接受调强放射治疗（IMRT）的患者可能会出现放疗疗程未完成（NCRC）的情况。分析NCRC的原因和危险因素有助于采取针对性措施降低其发生率。这项为期六年的回顾性研究将对来自单一中心的NCRC进行队列分析。
收集2018年1月至2023年12月接受IMRT治疗患者的数据进行分析。收集的特征包括年龄、性别、居住地区、体重指数（BMI）、肿瘤临床分期、肿瘤类型、肿瘤位置、治疗目的、分次次数、保险状况、治疗完成情况以及NCRC的原因。放疗过程严格遵循中国放疗质量控制基本指南。NCRC定义为开始放疗后未完成疗程。患者分为完成组（CG）和未完成组（NCG）。综合分析包括六年总体NCRC率及年度趋势、组间（CG与NCG）特征差异、NCRC的原因和危险因素。
在总共收集的2112例IMRT患者中，NCRC的总体发生率为5.68%（n = 120），年度发生率在4.15% - 6.69%之间（p = 0.718）。患者自身导致NCRC的原因包括：认为最后几次分次不必要（n = 8，6.67%）；认为治疗效果不足（n = 34，28.33%）；经济限制（n = 3，2.5%）。临床医生导致NCRC的原因包括：严重的放射诱导毒性（n = 39，32.5%）；疾病进展（n = 30，25%）；死亡（n = 6，5%）。在年龄、性别、体重指数（BMI）、治疗目的、肿瘤临床分期、肿瘤位置和分次次数方面观察到组间（CG与NCG）存在显著差异（p < 0.05）；然而在居住地区和保险状况方面未观察到显著差异。多因素分析显示年龄、BMI、治疗目的和肿瘤临床分期是NCRC的独立危险因素（p < 0.05）。
严格遵守放疗质量控制基本指南有助于维持稳定的NCRC发生率（在4.15% - 6.69%之间）。虽然62.5%的NCRC病例归因于不可预测的放射诱导毒性、疾病进展或死亡，但其余37.5%（35%是由于对放疗认识不足，2.5%是由于经济限制）是潜在可预防的。这些发现强调需要实施风险分层干预措施来解决可改变的障碍并降低NCRC发生率，特别是在以高龄、低BMI、较晚临床肿瘤分期和姑息性放疗目的为特征的高风险亚组中。
