Prolongation of definitive head and neck cancer radiotherapy: Survival impact and predisposing factors

医学 内科学 四分位数 比例危险模型 头颈部癌 癌症 放射治疗 混淆 共病 队列 逻辑回归 延长 倾向得分匹配 危险系数 肿瘤科 外科 置信区间
作者
Michael Xiang,Michael F. Gensheimer,Erqi L. Pollom,Floyd Christopher Holsinger,A. Dimitrios Colevas,Quynh‐Thu Le,Beth M. Beadle
出处
期刊:Radiotherapy and Oncology [Elsevier BV]
卷期号:156: 201-208 被引量:16
标识
DOI:10.1016/j.radonc.2020.12.025
摘要

Abstract

Background and purpose

To quantify the survival impact of prolongation of definitive radiotherapy (RT) for head and neck cancer in a national, modern cohort, and to identify predictive factors for prolongation.

Materials and methods

The National Cancer Database was queried for adults with non-metastatic cancer of the nasopharynx, oropharynx, larynx, or hypopharynx diagnosed 2004–2015, treated with definitive RT to 66–70 Gy in 30–35 fractions at 2–2.2 Gy per fraction. Multivariable Cox regression and propensity score matching were used to model the survival impact of RT prolongation, adjusting for potential confounders such as age and comorbidity. Predictors of RT prolongation were identified using multivariable multinomial logistic regression.

Results

In total, 36,367 patients were identified. As a continuous variable, RT prolongation increased the relative hazard of death by 2% per day (P < .0001). In the matched cohorts, patients with short (4–8 days) or long prolongation (>8 days) had lower absolute 4-year overall survival by 4% and 12%, respectively (P < .0001), while prolongation of 1–3 days was not significantly adverse. Major predictors of increased risk of prolongation were administration of systemic therapy, baseline comorbidity, lack of private insurance, and tumor/nodal stage. Conversely, higher facility volume was significantly protective, with a 55% lower risk of long prolongation within the topmost quartile (>11.5 patients/year).

Conclusion

RT prolongation, especially >8 days, is significantly deleterious. Systemic therapy and facility volume were major predictors. Early identification of patients at increased risk of treatment interruptions may facilitate implementation of preventive measures.
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