Trends in intensity modulated radiation therapy use for locally advanced rectal cancer at National Comprehensive Cancer Network centers
Trends in intensity modulated radiation therapy use for locally advanced rectal cancer at National Comprehensive Cancer Network centers
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DOI：
10.1016/j.adro.2017.10.001
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发表时间：
2018-01-01
影响因子：
2.3
通讯作者：
Goodman, Karyn A.
中科院分区：
文献类型：
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作者：
Reyngold, Marsha;Niland, Joyce;Goodman, Karyn A.
目的：调强适形放射治疗(IMRT)以其优于三维适形放射治疗(CRT)的技术优势，迅速进入临床应用。我们描述了2005-2011年间国家综合癌症网络癌症中心在局部晚期直肠癌综合治疗中采用调强放疗的趋势。方法和材料：利用国家综合癌症网络结直肠癌数据库，我们确定了2005-2011年间在捐献中心接受盆腔放射治疗的976例II-III期直肠癌患者的治疗模式。多变量Logistic回归用于确定与调强放疗和三维适形放疗相关的因素。结果：947例患者(97%)接受三维适形放射治疗(80%)或调强适形放射治疗(17%)。其中98%的患者在手术前接受了放射治疗，81%的患者接受了明确的切除。调强放射治疗的使用率从2010年的30%上升到此后的30%，不同机构之间存在显著差异(范围为0%-43%)。其他与调强放射治疗相关的因素包括：年龄65岁，剂量50.4GY，非裔美国人，没有做过经腹手术。两组的放射治疗完成率和完成时间相似。结论：尽管2005-2011年间，在被查询的国家癌症研究所指定的癌症中心，大多数II-III期直肠癌患者接受了三维CRT，但接受调强放疗的人数显著增加。调强放射治疗的应用在不同机构之间差异很大，在社会人口学群体中也不一致，但在特定的临床环境中可能更一致地被接受。鉴于这一趋势，需要进行比较有效性研究来评估调强放疗对直肠癌的益处。(三)2017年提交人(S)。由爱思唯尔公司代表美国放射肿瘤学会出版。
Purpose: Intensity modulated radiation therapy (IMRT) has been rapidly incorporated into clinical practice because of its technological advantages over 3-dimensional conformal radiation therapy (CRT). We characterized trends in IMRT utilization in trimodality treatment of locally advanced rectal cancer at National Comprehensive Cancer Network cancer centers between 2005 and 2011.Methods and materials: Using the prospective National Comprehensive Cancer Network Colorectal Cancer Database, we determined treatment patterns for 976 patients with stage II-III rectal cancer who received pelvic radiation therapy at contributing centers between 2005 and 2011. Multivariable logistic regression was used to identify factors associated with IMRT versus 3-dimensional CRT. Radiation therapy compliance and time to completion were used to compare acute toxicity.Results: A total of 947 patients (97%) received 3-dimensional CRT (80%) or IMRT (17%). Ninety-eight percent of these patients received radiation therapy preoperatively, and 81% underwent definitive resection. IMRT use increased from 30% in 2010 and thereafter, with significant variability among institutions (range, 0%-43%). Other factors associated with IMRT use included age >= 65 years, dose >50.4 Gy, African-American race, and no transabdominal surgery. Rates of and time to radiation therapy completion were similar between the groups.Conclusions: Although most patients with stage II-III rectal cancer at queried National Cancer Institute-designated cancer centers between 2005 and 2011 received 3-dimensional CRT, significant and increasing numbers received IMRT. IMRT utilization is highly variable among institutions and not uniform among sociodemographic groups but may be more consistently embraced in specific clinical settings. Given this trend, comparative-effectiveness research is needed to evaluate the benefits of IMRT for rectal cancer. (C) 2017 The Author(s). Published by Elsevier Inc. on behalf of the American Society for Radiation Oncology.