期刊论文详细信息
Frontiers in Oncology
Proton vs. Photon Radiation Therapy for Primary Gliomas: An Analysis of the National Cancer Data Base
Yuan Liu1  En Cheng1  Alfredo Voloschin2  Jeffrey J. Olson3  Jaymin Jhaveri4  Ian R. Crocker4  Zachary Buchwald4  Mark W. McDonald4  Bree R. Eaton4  Walter J. Curran4  Sibo Tian4  Mudit Chowdhary5  Aidnag Z. Diaz5  Theresa W. Gillespie6  Kirtesh R. Patel7 
[1] Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, United States;Department of Hematology and Medical Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, United States;Department of Neurosurgery and Winship Cancer Institute, Emory University, Atlanta, GA, United States;Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, United States;Department of Radiation Oncology, Rush University, Chicago, IL, United States;Department of Surgery, Emory University, Atlanta, GA, United States;Department of Therapeutic Radiology, Yale University, New Haven, CT, United States;
关键词: proton therapy;    gliomas;    overall survival;    IMRT;    NCDB;   
DOI  :  10.3389/fonc.2018.00440
来源: DOAJ
【 摘 要 】

Background: To investigate the impact of proton radiotherapy (PBT) on overall survival (OS) and evaluate PBT usage trends for patients with gliomas in the National Cancer Data Base (NCDB).Methods: Patients with a diagnosis of World Health Organization (WHO) Grade I-IV glioma treated with definitive radiation therapy (RT) between the years of 2004–13 were identified. Patients were stratified based on WHO Grade and photon radiotherapy (XRT) vs. PBT. Univariate (UVA) and multivariable analysis (MVA) with OS were performed by Cox proportional hazards model and log-rank tests. Propensity score (PS) weighting was utilized to account for differences in patient characteristics and to minimize selection bias.Results: There were a total of 49,405 patients treated with XRT and 170 patients treated with PBT. Median follow-up time was 62.1 months. On MVA, the following factors were associated with receipt of PBT (all p < 0.05): WHO Grade I-II gliomas, treatment at an academic/research program, west geographic facility location, and surgical resection. After PS weighting, all patients treated with PBT were found to have superior median and 5 year survival than patients treated with XRT: 45.9 vs. 29.7 months (p = 0.009) and 46.1 vs. 35.5% (p = 0.0160), respectively.Conclusions: PBT is associated with improved OS compared to XRT for patients with gliomas. This finding warrants verification in the randomized trial setting in order to account for potential patient imbalances not adequately captured by the NCDB, such as tumor molecular characteristics and patient performance status.Importance of the Study: This is the first study that compares the outcomes of patients treated with photon based radiotherapy vs. proton based radiotherapy for patients with gliomas. In this retrospective analysis, the results demonstrate that proton therapy is associated with improved outcomes which support ongoing prospective, randomized clinical trials comparing the two modalities in patients with gliomas.

【 授权许可】

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