Patterns-of-care in Proton Radiotherapy for Pediatric Central Nervous System Malignancies
Menée aux Etats-Unis à partir des données du registre national des cancers portant sur 4 637 patients pédiatriques atteints d'une tumeur primitive du système nerveux central diagnostiquée entre 2004 et 2012, cette étude identifie les facteurs prédictifs associés à l'utilisation de la protonthérapie
Purpose : Proton beam therapy (PBT) potentially allows for improved sparing of normal tissues, hopefully leading to decreased late side effects in children. Using a national registry, we sought to perform a patterns-of-care analysis for children receiving PBT for primary CNS malignancies. Methods and Materials : Using the National Cancer Data Base (NCDB), we identified pediatric patients with primary CNS malignancies who were diagnosed between 2004 and 2012. We utilized a standard t-test for comparison of means and chi-square to identify differences in demographic and clinical characteristics. Univariate and multivariate logistical regression was applied to identify predictors of PBT use. Results : We identified 4,637 pediatric patients receiving radiation therapy from 2004 to 2012, including a subset of 267 patients treated with PBT. We found PBT utilization increased with time from <1% in 2004 to 15% in 2012. In multivariate logistical regression, we found the following to be predictors of receipt of PBT: private insurance, the highest income bracket, younger age, living in a metropolitan area, and residing >200 miles from a radiation treatment facility (p<0.05). Conclusions : In conclusion, we noted the proportion of children receiving PBT to be significantly increasing over time from <1% to 15% from 2004-2012. We also observed important disparities in receipt of PBT based on socioeconomic status. Children from higher income households and with private insurance were more likely to utilize this expensive technology. As we continue to demonstrate the potential benefits of PBT in children, efforts are needed to expand accessibility of PBT for children of all socioeconomic backgrounds and regions of the country.