William A Stokes1, Diana Abbott2, Andy Phan1, David Raben1, Ryan M Lanning1, Sana D Karam3. 1. Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. 2. Colorado Biostatistics Consortium, Colorado School of Public Health, Aurora, Colorado. 3. Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: sana.karam@ucdenver.edu.
Abstract
PURPOSE: To characterize practice patterns, including temporal trends, in fractionation schedules among patients in the United States undergoing definitive radiation therapy for early-stage glottic cancer and to compare overall survival outcomes between fractionation schedules. METHODS AND MATERIALS: We queried the National Cancer Database for patients with TisN0M0, T1N0M0, or T2N0M0 squamous cell carcinoma of the glottic larynx diagnosed between 2004 and 2012 and undergoing definitive radiation therapy. Dose per fraction was calculated to define cohorts undergoing conventional fractionation (CFxn) and hypofractionation (HFxn). Logistic regression was performed to identify predictors of receiving HFxn, and Cox regression was used to determine predictors of death. One-to-one propensity score matching was then used to compare survival between fractionation schedules. RESULTS: The study included 10,539 patients, with 6576 undergoing CFxn and 3963 undergoing HFxn. Patients with T1 disease comprised a majority of each cohort. Use of HFxn increased significantly over the period studied (P<.001), but even in the final year, nearly one-half of patients continued to receive CFxn. Receipt of HFxn was also independently associated with higher income and facility types other than community cancer programs on logistic regression. On multivariate Cox regression, HFxn was associated with improved survival (hazard ratio [HR] for death, 0.90; 95% confidence interval [CI], 0.83-0.97; P=.008), a finding redemonstrated on univariate Cox regression among a well-matched cohort after propensity score matching (HR, 0.88; 95% CI, 0.80-0.96; P=.003). Subgroup Cox multivariate analysis demonstrated a significant survival advantage with HFxn among patients with T1 disease (HR, 0.90; 95% CI, 0.81-0.99; P=.042) but a nonsignificant benefit among those with Tis (HR, 0.86; 95% CI, 0.57-1.30; P=.472) or T2 (HR, 0.88; 95% CI, 0.76-1.02; P=.099) disease. CONCLUSIONS: Use of HFxn is increasing and is associated with improved survival over CFxn. Our findings support the broadened use of HFxn for patients with early-stage glottic cancer undergoing definitive radiation therapy.
PURPOSE: To characterize practice patterns, including temporal trends, in fractionation schedules among patients in the United States undergoing definitive radiation therapy for early-stage glottic cancer and to compare overall survival outcomes between fractionation schedules. METHODS AND MATERIALS: We queried the National Cancer Database for patients with TisN0M0, T1N0M0, or T2N0M0 squamous cell carcinoma of the glottic larynx diagnosed between 2004 and 2012 and undergoing definitive radiation therapy. Dose per fraction was calculated to define cohorts undergoing conventional fractionation (CFxn) and hypofractionation (HFxn). Logistic regression was performed to identify predictors of receiving HFxn, and Cox regression was used to determine predictors of death. One-to-one propensity score matching was then used to compare survival between fractionation schedules. RESULTS: The study included 10,539 patients, with 6576 undergoing CFxn and 3963 undergoing HFxn. Patients with T1 disease comprised a majority of each cohort. Use of HFxn increased significantly over the period studied (P<.001), but even in the final year, nearly one-half of patients continued to receive CFxn. Receipt of HFxn was also independently associated with higher income and facility types other than community cancer programs on logistic regression. On multivariate Cox regression, HFxn was associated with improved survival (hazard ratio [HR] for death, 0.90; 95% confidence interval [CI], 0.83-0.97; P=.008), a finding redemonstrated on univariate Cox regression among a well-matched cohort after propensity score matching (HR, 0.88; 95% CI, 0.80-0.96; P=.003). Subgroup Cox multivariate analysis demonstrated a significant survival advantage with HFxn among patients with T1 disease (HR, 0.90; 95% CI, 0.81-0.99; P=.042) but a nonsignificant benefit among those with Tis (HR, 0.86; 95% CI, 0.57-1.30; P=.472) or T2 (HR, 0.88; 95% CI, 0.76-1.02; P=.099) disease. CONCLUSIONS: Use of HFxn is increasing and is associated with improved survival over CFxn. Our findings support the broadened use of HFxn for patients with early-stage glottic cancer undergoing definitive radiation therapy.
Authors: S Short; H Krawitz; A Macann; T West; R P Morton; N P McIvor; J Chaplin; P Simcock; J Gathercole; B Dorman; A Hindley Journal: Australas Radiol Date: 2006-04
Authors: John A Ridge; Joshua Lawson; Sue S Yom; Madhur Kumar Garg; Mark W McDonald; Harry Quon; Nabil Saba; Joseph K Salama; Richard V Smith; Francis Worden; Anamaria Reyna Yeung; Jonathan J Beitler Journal: Head Neck Date: 2013-09-18 Impact factor: 3.147
Authors: David G Pfister; Sharon Spencer; David M Brizel; Barbara Burtness; Paul M Busse; Jimmy J Caudell; Anthony J Cmelak; A Dimitrios Colevas; Frank Dunphy; David W Eisele; Robert L Foote; Jill Gilbert; Maura L Gillison; Robert I Haddad; Bruce H Haughey; Wesley L Hicks; Ying J Hitchcock; Antonio Jimeno; Merrill S Kies; William M Lydiatt; Ellie Maghami; Thomas McCaffrey; Loren K Mell; Bharat B Mittal; Harlan A Pinto; John A Ridge; Cristina P Rodriguez; Sandeep Samant; Jatin P Shah; Randal S Weber; Gregory T Wolf; Frank Worden; Sue S Yom; Nicole McMillian; Miranda Hughes Journal: J Natl Compr Canc Netw Date: 2015-07 Impact factor: 11.908
Authors: Ian Ganly; Snehal G Patel; Jeannette Matsuo; Bhuvanesh Singh; Dennis H Kraus; Jay O Boyle; Richard J Wong; Ashok R Shaha; Nancy Lee; Jatin P Shah Journal: Arch Otolaryngol Head Neck Surg Date: 2006-01
Authors: M P McLaughlin; J T Parsons; D A Fein; S P Stringer; N J Cassisi; W M Mendenhall; R R Million Journal: Head Neck Date: 1996 May-Jun Impact factor: 3.147
Authors: Allie Garcia-Serra; Russell W Hinerman; Robert J Amdur; Christopher G Morris; William M Mendenhall Journal: Head Neck Date: 2002-04 Impact factor: 3.147
Authors: Neil Sengupta; Christopher G Morris; Jessica Kirwan; Robert J Amdur; William M Mendenhall Journal: Am J Clin Oncol Date: 2010-02 Impact factor: 2.339
Authors: Sung Ho Moon; Kwan Ho Cho; Eun Ji Chung; Chang Geol Lee; Kyu Chan Lee; Gyu-Young Chai; Ki Mun Kang; Jong Young Lee; Woong-Ki Chung; Woo Yoon Park; Jin Hee Kim Journal: Radiother Oncol Date: 2013-10-22 Impact factor: 6.280
Authors: B G Salas-Salas; D J Domínguez-Nuez; R Cabrera; L Ferrera-Alayón; M Lloret; P C Lara Journal: Clin Transl Oncol Date: 2019-06-01 Impact factor: 3.405
Authors: Olgun Elicin; Ekin Ermiş; Christoph Oehler; Daniel M Aebersold; Francesca Caparrotti; Frank Zimmermann; Gabriela Studer; Guido Henke; Lukas Adam; Lukas Anschuetz; Mahmut Ozsahin; Matthias Guckenberger; Mohamed Shelan; Nuri Kaydıhan; Oliver Riesterer; Robin J D Prestwich; Thierry Spielmann; Roland Giger; Mehmet Şen Journal: Front Oncol Date: 2019-09-20 Impact factor: 6.244
Authors: Olgun Elicin; Paul Martin Putora; Marco Siano; Martina A Broglie; Christian Simon; Daniel Zwahlen; Gerhard F Huber; Giorgio Ballerini; Lorenza Beffa; Roland Giger; Sacha Rothschild; Sandro V Negri; Pavel Dulguerov; Guido Henke Journal: Front Oncol Date: 2019-10-24 Impact factor: 6.244
Authors: Mark C Korpics; W Tyler Turchan; Michael K Rooney; Matthew Koshy; Michael T Spiotto Journal: Cancers (Basel) Date: 2019-12-12 Impact factor: 6.639