Radiation modality use and cardiopulmonary mortality risk in elderly patients with esophageal cancer.
Radiation modality use and cardiopulmonary mortality risk in elderly patients with esophageal cancer.
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DOI：
10.1002/cncr.29857
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发表时间：
2016-03-15
期刊：
影响因子：
6.2
通讯作者：
Giordano SH
中科院分区：
文献类型：
--
作者：
Lin SH;Zhang N;Godby J;Wang J;Marsh GD;Liao Z;Komaki R;Ho L;Hofstetter WL;Swisher SG;Mehran RJ;Buchholz TA;Elting LS;Giordano SH
目前尚不清楚调强放射治疗（IMRT）与三维放射治疗（3D）相比的上级正常器官保留效果是否对食管癌（EC）患者的生存率和心肺死亡率有临床影响。我们从SEER/Texas Cancer Registry-Medicare数据库中确定了2，553例年龄大于65岁的患者，他们在2002年至2009年期间诊断为非转移性EC，并在诊断后6个月内接受了3D（n= 2，240）或IMRT（n=313）治疗。使用治疗权重逆概率（IPTW）调整比较两个队列的结局。除婚姻状况、诊断年份和SEER地区外，两个放射队列的各种患者、肿瘤和治疗特征（包括在城市/都市或农村地区使用调强放疗与3D）平衡良好。IMRT的使用率从2002年的2.6%上升到2009年的30%，而3D的使用率从2002年的97.4%下降到2009年的70%。在倾向评分IPTW调整的多变量分析中，IMRT与EC特异性死亡率无关（HR 0.93，95%CI 0.80-1.10）或肺部死亡（HR 1.11，95%CI 0.37-3.36），但与全因死亡率降低显著相关（HR 0.83，95%CI 0.72-0.95）、心源性死亡率（HR 0.18，95%CI 0.06-0.54）和其他原因死亡率（HR 0.54，95%CI 0.35-0.84）。在调整了化疗类型、医生经验和敏感性分析（去除混合放射声明）后，也观察到了类似的相关性。在这项基于人群的分析中，调强放射治疗与EC患者的全因死亡率、心源性死亡率和其他原因死亡率降低显著相关。目前尚不清楚与三维适形放射治疗（3D）相比，调强放射治疗（IMRT）保留器官的剂量学优势是否可以转化为食管癌患者的生存率和心肺死亡率获益。这项SEER/Texas Cancer Registry-Medicare基于人群的研究发现，虽然癌症或肺部特异性死亡率没有差异，但在倾向评分调整的多变量分析下，IMRT治疗患者的全因和心脏特异性死亡率显着降低。
It is currently unclear if the superior normal organ sparing effect of Intensity Modulated Radiation Therapy (IMRT) as compared to three-dimensional radiation therapy (3D) has clinical impact on survival and cardiopulmonary mortality in esophageal cancer (EC) patients. We identified 2,553 patients older than age 65 years from the SEER/Texas Cancer Registry-Medicare databases who had non-metastatic EC diagnosed between 2002 and 2009 and were treated with either 3D (n=2,240) or IMRT (n=313) within 6 months of diagnosis. The outcomes of the two cohorts were compared using Inverse Probability of Treatment Weighting (IPTW) adjustment. Except for marital status, year of diagnosis, and SEER region, both radiation cohorts were well balanced for various patient, tumor, and treatment characteristics, including the use of IMRT vs. 3D in urban/metro or rural areas. IMRT use increased from 2.6% in 2002 to 30% in 2009, while 3D use decreased from 97.4% in 2002 to 70% in 2009. On propensity score IPTW-adjusted multivariate analysis, IMRT was not associated with EC-specific mortality (HR 0.93, 95%CI 0.80-1.10) or pulmonary mortality (HR 1.11, 95%CI 0.37-3.36) but was significantly associated with lower all-cause mortality (HR 0.83, 95%CI 0.72-0.95), cardiac mortality (HR 0.18, 95%CI 0.06-0.54) and other cause mortality (HR 0.54, 95%CI 0.35-0.84). Similar associations were seen after adjusting for the type of chemotherapy, physician experience, and sensitivity analysis removing hybrid radiation claims. In this population-based analysis, IMRT use was significantly associated with lower all-cause mortality, cardiac mortality, and other-cause mortality in EC patients. It is currently unclear if the dosimetric advantages of organ sparing by Intensity Modulated Radiation Therapy (IMRT) compared to three dimensional conformal radiation therapy (3D) can translate to survival and cardiopulmonary mortality benefit in esophageal cancer patients. This SEER/Texas Cancer Registry-Medicare population-based study found that while there were no differences in cancer or pulmonary-specific mortality, all-cause and cardiac-specific mortality were significantly reduced in IMRT-treated patients under a propensity score adjusted multivariate analysis.
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DOI：
10.1016/j.ijrobp.2009.02.032
发表时间：
2010-03-01
影响因子：
7
作者：
Liao, Zhongxing X.;Komaki, Ritsuko R.;Cox, James D.
通讯作者：
Cox, James D.
影响因子：
158.5
作者：
Darby, Sarah C.;Ewertz, Marianne;Hall, Per
通讯作者：
Hall, Per
DOI：
10.1016/j.ijrobp.2013.04.006
发表时间：
2013-08-01
影响因子：
7
作者：
Wang, Jingya;Wei, Caimiao;Tucker, Susan L.;Myles, Bevan;Palmer, Matthew;Hofstetter, Wayne L.;Swisher, Stephen G.;Ajani, Jaffer A.;Cox, James D.;Komaki, Ritsuko;Liao, Zhongxing;Lin, Steven H.
通讯作者：
Lin, Steven H.
影响因子：
8.8
作者：
Henson, K. E.;McGale, P.;Taylor, C.;Darby, S. C.
通讯作者：
Darby, S. C.
影响因子：
7.8
作者：
Lohia, Shivangi;Rajapurkar, Mayuri;Day, Terry A.
通讯作者：
Day, Terry A.