National Cancer DataBase Analysis of Proton versus Photon Radiotherapy in Non-Small Cell Lung Cancer (NSCLC)
Menée à partir des données du registre national américain des cancers portant sur 243 822 patients atteints d'un cancer du poumon non à petites cellules de stade I-IV traité entre 2004 et 2012, cette étude compare, en fonction du stade de la maladie et du point de vue de la survie globale à 5 ans, l'efficacité d'une protonthérapie et d'une radiothérapie par faisceaux de photons
Purpose : Whether survival is improved with proton radiotherapy relative to photon radiotherapy in NSCLC patients is unknown. We analyzed outcomes and predictors associated with proton radiotherapy for NSCLC in the National Cancer DataBase (NCDB). Methods and Materials : The NCDB was queried to capture patients (pts) with stage I-IV NSCLC treated with thoracic radiation from 2004-2012. A logistic regression model was used to determine the predictors for utilization of proton radiotherapy. The univariate and multivariable association with OS were assessed by Cox proportional hazards models along with log-rank tests. Propensity score matching method was implemented to balance baseline covariates and eliminate selection bias. Results : A total of 243,822 patients (photon radiotherapy-243,474; proton radiotherapy- 348) were included in the analysis. Patients in a zip code with a median income of less than $46,000 per year were less likely to receive proton treatment, with the income cohort of $30,000-$35,999 least likely to receive proton therapy [OR 0.63 (0.44 – 0.90); p=0.011]. On multivariate analysis of all patients, non-proton therapy was associated with significantly worse survival compared to proton therapy [HR 1.21 (1.06-1.39), p<0.01]. On propensity matched analysis, proton radiotherapy (n = 309) was associated with better 5 year OS compared to non-proton radiotherapy (n= 1549), 22% vs. 16%; p=0.025. For stage II and III patients, non-proton radiotherapy was associated with worse survival compared to proton radiotherapy [HR 1.35 (95%CI 1.10-1.64), p < 0.01]. Conclusions : Thoracic radiation with protons is associated with better survival in this retrospective analysis; further validation in the randomized setting is needed to account for any imbalances in patient characteristics, including PET-CT staging.
http://www.redjournal.org/article/S0360-3016(16)33275-8/fulltext 2016