Intensity-modulated proton therapy versus volumetric-modulated ARC therapy in patients with nasopharyngeal carcinoma: A long-term, multicenter cohort study.

IF 4.9 1区 医学 Q1 ONCOLOGY
Radiotherapy and Oncology Pub Date : 2025-01-01 Epub Date: 2024-11-23 DOI:10.1016/j.radonc.2024.110648
Ching-Nung Wu, Jung-Der Wang, Wei-Chih Chen, Chung-Ying Lin, Tai-Jan Chiu, Yao-Hsu Yang, Joseph Tung-Chieh Chang, Sheng-Dean Luo, Yu-Ming Wang
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引用次数: 0

Abstract

Background: Data evaluating the impact of intensity-modulated proton therapy (IMPT) on survival among nasopharyngeal carcinoma (NPC) patients are limited. This study aims to elucidate the survival benefits and toxicity profiles of IMPT compared to modern photon therapy, volumetric-modulated arc therapy (VMAT), over an extended follow-up period.

Methods: We analyzed data from NPC patients recorded in the Chang Gung Research Database. This analysis focused on individuals who received definitive radiotherapy, either IMPT or VMAT therapy, from 2016 to 2021. Patients with distant metastasis or concurrent other malignancies were excluded. We performed 1:1 matching based on stage, year of diagnosis, and age (± 10 years). Oncological outcomes and toxicities were assessed using Cox proportional hazards modeling. For sensitivity analysis, we employed inverse probability of treatment weighting and additional 1:2 matching.

Results: Out of a 1,202 NPC patients' cohort, 276 were selected from a subset of 294 who received IMPT and matched with an equivalent number of patients receiving VMAT. IMPT was associated with improved oncological outcomes after matching, with an adjusted hazard ratio (aHR) of 0.31 (95% CI: 0.15-0.62) for all-cause mortality and an aHR of 0.58 (95% CI: 0.34-0.99) for disease recurrence. Additionally, IMPT was linked to a reduced incidence of feeding tube placement, with an aHR of 0.31 (95% CI: 0.18-0.55). Competing risk and sensitivity analyses corroborated these trends, though the significance for disease recurrence was not consistent.

Conclusion: IMPT was associated with significantly better overall survival outcomes and a lower incidence of dysphagia compared to VMAT in NPC patients. Further randomized trials are needed to confirm these findings.

鼻咽癌患者的强度调制质子疗法与体积调制 ARC疗法: 一项长期多中心队列研究。
背景:评估强度调制质子疗法(IMPT)对鼻咽癌(NPC)患者生存期影响的数据非常有限。本研究旨在阐明 IMPT 与现代光子疗法、体积调制弧疗法(VMAT)相比,在较长的随访期内对患者生存的益处和毒性的影响:我们分析了长庚研究数据库中记录的鼻咽癌患者数据。本次分析的重点是在2016年至2021年期间接受了IMPT或VMAT治疗的确定性放疗的患者。排除了远处转移或同时患有其他恶性肿瘤的患者。我们根据分期、诊断年份和年龄(± 10 岁)进行了 1:1 匹配。采用 Cox 比例危险度模型评估肿瘤结局和毒性。在敏感性分析中,我们采用了治疗的反概率加权和额外的 1:2 匹配:在1202名鼻咽癌患者队列中,从294名接受IMPT治疗的患者子集中选出了276名患者,并与同等数量的接受VMAT治疗的患者进行了配对。匹配后,IMPT 与肿瘤预后的改善相关,全因死亡率的调整危险比 (aHR) 为 0.31(95% CI:0.15-0.62),疾病复发的调整危险比 (aHR) 为 0.58(95% CI:0.34-0.99)。此外,IMPT 与喂食管置入率降低有关,其 aHR 为 0.31(95% CI:0.18-0.55)。竞争风险和敏感性分析证实了这些趋势,但疾病复发的意义并不一致:结论:与VMAT相比,IMPT与鼻咽癌患者更好的总体生存结果和更低的吞咽困难发生率相关。需要进一步的随机试验来证实这些发现。
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
Radiotherapy and Oncology
Radiotherapy and Oncology 医学-核医学
CiteScore
10.30
自引率
10.50%
发文量
2445
审稿时长
45 days
期刊介绍: Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.
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