背景:目前尚不清楚调强放疗(IMRT)与三维放疗(3D)相比是否具有优越的正常器官保护作用,对食管癌(EC)患者的生存率和心肺死亡率具有临床影响。
方法:作者从监测中确定了2553名年龄>65岁的患者,流行病学,和最终结果(SEER)-Medicare和TexasCancerRegistry-Medicare数据库,在2002年至2009年间诊断出非转移性EC,并在诊断后6个月内接受3D(2240例)或IMRT(313例)治疗。使用治疗加权调整的逆概率比较2组的结果。
结果:除了婚姻状况,诊断年份,SEER区域,两个辐射队列对于不同的患者都很平衡,肿瘤,和治疗特点,包括在城市/大都市或农村地区使用IMRT与3D。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%。关于倾向评分逆概率的治疗加权调整多变量分析,未发现IMRT与EC特异性死亡率相关(风险比[HR],0.93;95%置信区间[95%CI],0.80-1.10)或肺部死亡率(HR,1.11;95%CI,0.37-3.36),但与较低的全因死亡率显著相关(HR,0.83;95%CI,0.72-0.95),心脏死亡率(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)。在调整化疗类型后发现了类似的关联,医师经验,和敏感性分析,消除混合辐射索赔。
结论:在这项基于人群的分析中,发现使用IMRT与较低的全因死亡率显着相关,心脏死亡率,EC患者的其他原因死亡率。
BACKGROUND: It is currently unclear whether the superior normal organ-sparing effect of intensity-modulated radiotherapy (IMRT) compared with 3-dimensional radiotherapy (3D) has a clinical impact on survival and cardiopulmonary mortality in patients with esophageal cancer (EC).
METHODS: The authors identified 2553 patients aged > 65 years from the Surveillance, Epidemiology, and End Results (SEER)-Medicare and Texas Cancer Registry-Medicare databases who had nonmetastatic EC diagnosed between 2002 and 2009 and were treated with either 3D (2240 patients) or IMRT (313 patients) within 6 months of diagnosis. The outcomes of the 2 cohorts were compared using inverse probability of treatment weighting adjustment.
RESULTS: Except for marital status, year of diagnosis, and SEER region, both radiation cohorts were well balanced with regard to various patient, tumor, and treatment characteristics, including the use of IMRT versus 3D in urban/metropolitan or rural areas. IMRT use increased from 2.6% in 2002 to 30% in 2009, whereas the use of 3D decreased from 97.4% in 2002 to 70% in 2009. On propensity score inverse probability of treatment weighting-adjusted multivariate analysis, IMRT was not found to be associated with EC-specific mortality (hazard ratio [HR], 0.93; 95% confidence interval [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 noted after adjusting for the type of chemotherapy, physician experience, and sensitivity analysis removing hybrid radiation claims.
CONCLUSIONS: In this population-based analysis, the use of IMRT was found to be significantly associated with lower all-cause mortality, cardiac mortality, and other-cause mortality in patients with EC.