国家癌症数据库对无法手术的子宫内膜癌放射治疗合并模式和剂量的分析。

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2024-11-01 DOI:10.1016/j.brachy.2024.06.005

Alexander Lukez , Brian L. Egleston , Peter L. Lee , Krisha J. Howell , Jeremy G. Price

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引用次数: 0

摘要

目的：我们利用全国癌症数据库（NCDB）评估了有局部病变、无法手术的子宫内膜癌（EC）患者的放射治疗（RT）增强方式和总剂量的趋势和结果：方法：对国际妇产科联盟（FIGO）I - IIIC2期无法手术的子宫内膜癌患者进行了分析，这些患者接受了RT和化疗治疗。比较了体外射束 RT（EBRT）与高剂量率近距离放射治疗（BT）的实践模式和 RT 总剂量（姑息性：≤3000 cGy，确定性低剂量 [DLD]：4500 - 6249 cGy）：4500 - 6249 cGy，最终高剂量[DHD]：≥6250 cGy）。Kaplan-Meier法评估了总生存期（OS），Cox比例危险模型评估了与OS相关的变量：NCDB共纳入1755例病例，其中1209例接受了放疗增强。从2004年到2019年，随着BT巩固治疗使用率的上升和姑息治疗率的下降，放疗增强方式的使用率也有所不同。III期疾病、黑人、N2疾病、分化不良或未分化分级是姑息剂量的预测因素。多变量分析发现，与 EBRT 相比，BT 增效与较低的死亡率相关（HR：0.81，CI：0.68-0.97；P = 0.019）。姑息治疗与 DHD 相比死亡率更高。与生存率较低相关的其他因素包括年龄增大、Charlson-Deyo评分较差、T期较高、N期较高以及中度、低度或未分化分级：自2004年以来，针对局部区域局限、无法手术的EC使用近距离放射治疗的情况有所增加。近距离放疗巩固治疗仍然是治疗无法手术的EC的有效RT方式，与EBRT巩固治疗相比，其死亡率更低。

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National Cancer Database analysis of radiation therapy consolidation modality and dose for inoperable endometrial cancer

OBJECTIVE

We utilized the National Cancer Database (NCDB) to evaluate trends and assess outcomes in radiation therapy (RT) boost modality and total dose among medically inoperable endometrial cancer (EC) patients with locoregional disease.

METHODS

Patients with International Federation of Gynecology and Obstetrics (FIGO) stage I – IIIC2 inoperable EC treated with RT ± chemotherapy were analyzed. Practice patterns compared external beam RT (EBRT) versus high-dose-rate brachytherapy (BT) boost and total RT dose (palliative: ≤3000 cGy, definitive low dose [DLD]: 4500 – 6249 cGy, definitive high dose [DHD]: ≥6250 cGy) over time. Kaplan-Meier method evaluated overall survival (OS) and Cox proportional hazard modeling assessed variables associated with OS.

RESULTS

NCDB included 1755 total cases, of which 1209 received a radiotherapy boost. From 2004 to 2019, boost modality rates differed with increasing utilization of BT consolidation and a decreasing rate of palliation. Predictors of a palliative dose were stage III disease, Black race, N2 disease, and poorly or undifferentiated grade. Multivariable analysis found BT boost was associated with lower mortality compared to EBRT (HR: 0.81, CI: 0.68–0.97; p = 0.019). Mortality rates were higher for palliation versus DHD. Additional factors associated with inferior survival were increasing age, worse Charlson-Deyo score, higher T stage, higher N stage, and moderately, poorly, or undifferentiated grade.

CONCLUSIONS

Utilization of BT boost for locoregionally confined, medically inoperable EC has increased since 2004. Brachytherapy consolidation remains an effective RT modality for medically inoperable EC, associated with lower mortality compared to EBRT consolidation.

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来源期刊

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.