GSOR10 Presentation Time: 5:45 PM

IF 1.7 4区 医学 Q4 ONCOLOGY
Darien N. Colson-Fearon M.P.H. , Akila Viswanathan M.D., M.P.H.
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引用次数: 0

Abstract

Purpose

According to the American Brachytherapy Society, brachytherapy (BT) is recommended for the treatment of vaginal cancer, particularly cases of bulky and/or recurrent disease. However, previous studies noted a decline in rates during the early 2010s in accordance with similar declines observed in the use of BT for cervical cancer treatment. Recent studies have demonstrated potential recovery in BT utilization in cervical cancer. As such, this study examines more recent trends in BT utilization for vaginal cancer from 2004 to 2020 to assess whether a similar reversal in trends has begun since increased recognition of the importance of BT.

Material and Methods

This study analyzed data from the National Cancer Database (NCDB) of all patients with FIGO stage I to IVA vaginal cancer treated with pelvic radiation therapy between 2004 and 2020, identifying 6,412 patients. Patients were excluded if they were missing radiation treatment details, or if their survival was less than 5 months. A univariate log binomial regression with robust variance was used to estimate incidence rate ratios (IRRs) of BT utilization overtime and identify potential risk factors associated with receipt. Factors found to be significant in univariate analysis were considered for inclusion in a multivariate model to assess for a relationship with BT use. Additionally, a Cochran Armitage test was conducted to assess for overall trends in BT use.

Results

Brachytherapy use increased from 48.0% in 2004 to 67.7% in 2020. In univariate analysis, when compared to 2004, utilization began to significantly increase starting in 2018. Additionally, the test for linear trend was statistically significant (p <0.01). In multivariate model, factors associated with increased brachytherapy use included having non-Medicaid/Medicare government insurance (IRR: 1.28 95% CI: 1.04 - 1.58) when compared to being uninsured, receiving care at an academic/research program (IRR: 1.35 95% CI: 1.16 - 1.57), integrated cancer program (IRR: 1.22 95% CI: 1.04 - 1.42) or other specified type of program (IRR: 1.42 95% CI: 1.14 - 1.78) when compared to community cancer programs, having squamous histology (IRR: 1.08 95% CI: 1.02 - 1.15), and diagnosis after 2018 (IRR: 1.29 95% CI: 1.19 - 1.40). Factors associated with decreased use included American Indian or Alaskan Native race (IRR: 0.57 95% CI: 0.33 - 0.98) when compared to white race, age over 80 (IRR: 0.67 95% CI: 0.61 - 0.77) when compared to age less than 50, and stage II (IRR: 0.94 95% CI: 0.87 - 0.96), III (IRR: 0.69 95% CI: 0.65 - 0.74), or IVA (IRR: 0.41 95% CI: 0.35 - 0.48) disease when compared to stage I. Finally, geographic differences were also observed in BT use. Receiving treating in facilities located in New England (IRR: 0.84 95% CI: 0.74 - 0.95), Middle Atlantic (IRR: 0.87 95% CI: 0.79 - 0.95), South Atlantic (IRR: 0.85 95% CI: 0.78 - 0.93), East North Central (IRR: 0.87 95% CI: 0.80 - 0.96), East South Central (IRR: 0.78 95% CI: 0.70 - 0.87), and West South Central (IRR: 0.70 95% CI: 0.62 - 0.79) census regions were associated with decreased receipt when compared to the West North Central.

Conclusions

In patients with FIGO stage I - IVA vaginal cancer treated with pelvic radiation therapy from 2004 to 2020, brachytherapy utilization has significantly increased starting in 2018. Receipt of brachytherapy is also associated with several sociodemographic factors, including insurance status, geographic location, age, and race. These results indicate a recent start of the reversal of previously identified declining use of brachytherapy. However, more work is needed to ensure equitable use across all demographic strata.
GSOR10 演讲时间:下午 5:45
目的根据美国近距离放射治疗协会(American Brachyapytherther Society)的建议,近距离放射治疗(BT)可用于治疗阴道癌,尤其是体积较大和/或复发的病例。然而,之前的研究表明,2010 年代初,近距离放射治疗阴道癌的使用率有所下降,这与宫颈癌治疗中近距离放射治疗使用率的下降相类似。最近的研究表明,宫颈癌 BT 的使用率有可能恢复。因此,本研究对 2004 年至 2020 年期间阴道癌 BT 利用率的最新趋势进行了研究,以评估自从人们越来越认识到 BT 的重要性之后,是否也开始出现类似的趋势逆转。材料与方法 本研究分析了 2004 年至 2020 年期间所有接受盆腔放疗的 FIGO I 期至 IVA 期阴道癌患者的全国癌症数据库(NCDB)数据,共识别出 6412 名患者。如果患者缺失放射治疗的详细信息,或生存期不足 5 个月,则将其排除在外。采用稳健方差的单变量对数二项式回归来估算超时使用 BT 的发病率比 (IRR),并确定与接受治疗相关的潜在风险因素。在单变量分析中发现的重要因素被考虑纳入多变量模型,以评估其与 BT 使用的关系。此外,还进行了 Cochran Armitage 检验,以评估 BT 使用的总体趋势。结果近距离放射治疗的使用率从 2004 年的 48.0% 增加到 2020 年的 67.7%。在单变量分析中,与 2004 年相比,使用率从 2018 年开始显著增加。此外,线性趋势检验具有统计学意义(p <0.01)。在多变量模型中,与近距离放射治疗使用增加相关的因素包括:与无保险相比,拥有非医疗补助/医疗保险政府保险(IRR:1.28 95% CI:1.04 - 1.58);在学术/研究项目中接受治疗(IRR:1.35 95% CI:1.16 - 1.57)、综合癌症项目(IRR:1.22 95% CI:1.04 - 1.42)或其他指定类型的项目(IRR:1.42 95% CI:1.14 - 1.78)(与社区癌症项目相比)、鳞状组织学(IRR:1.08 95% CI:1.02 - 1.15)和 2018 年后诊断(IRR:1.29 95% CI:1.19 - 1.40)。与使用减少相关的因素包括:美国印第安人或阿拉斯加原住民种族(IRR:0.57 95% CI:0.33 - 0.98)(与白人种族相比)、80 岁以上(IRR:0.67 95% CI:0.61 - 0.77)(与 50 岁以下相比)和 II 期(IRR:0.最后,还观察到 BT 使用的地域差异。在新英格兰(IRR:0.84 95% CI:0.74 - 0.95)、大西洋中部(IRR:0.87 95% CI:0.79 - 0.95)、大西洋南部(IRR:0.85 95% CI:0.78 - 0.93)、中北部东部(IRR:0.87 95% CI:0.80 - 0.96)、中南部东部(IRR:0.78 95% CI:0.70 - 0.87)和中南部西部(IRR:0.70 95% CI: 0.62 - 0.79)人口普查地区与中北部西部相比,接受治疗的人数减少。结论在 2004 年至 2020 年接受盆腔放疗的 FIGO I - IVA 期阴道癌患者中,近距离放射治疗的使用率从 2018 年开始显著增加。接受近距离放射治疗还与几个社会人口因素有关,包括保险状况、地理位置、年龄和种族。这些结果表明,之前发现的近距离治疗使用率下降趋势最近开始逆转。不过,还需要做更多的工作来确保所有人口阶层的公平使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Brachytherapy
Brachytherapy 医学-核医学
CiteScore
3.40
自引率
21.10%
发文量
119
审稿时长
9.1 weeks
期刊介绍: Brachytherapy is an international and multidisciplinary journal that publishes original peer-reviewed articles and selected reviews on the techniques and clinical applications of interstitial and intracavitary radiation in the management of cancers. Laboratory and experimental research relevant to clinical practice is also included. Related disciplines include medical physics, medical oncology, and radiation oncology and radiology. Brachytherapy publishes technical advances, original articles, reviews, and point/counterpoint on controversial issues. Original articles that address any aspect of brachytherapy are invited. Letters to the Editor-in-Chief are encouraged.
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