TY - JOUR
T1 - Intensity modulated radiotherapy for stage III non-small cell lung cancer in the United States
T2 - Predictors of use and association with toxicities
AU - Shirvani, Shervin M.
AU - Jiang, Jing
AU - Gomez, Daniel R.
AU - Chang, Joe Y.
AU - Buchholz, Thomas A.
AU - Smith, Benjamin D.
N1 - Funding Information:
Dr. Smith is supported by grants from the Cancer Prevention & Research Institute of Texas [Grant RP101207 ]. This work was also supported by the Department of Health and Human Services National Cancer Institute [Grants CA16672 and T32CA77050 ].
Funding Information:
A portion of this study was funded by a research grant from Varian Medical Systems ( SR2011-00034954RG 01 ). This entity had no role in the study design, data analysis, or data interpretation.
PY - 2013/11
Y1 - 2013/11
N2 - Background: Intensity modulated radiotherapy for stage III lung cancer has become commonplace in the United States in the absence of randomized controlled trials. We used a large, population-based database to determine which factors led to increased utilization of IMRT and to evaluate associations of IMRT with toxicities. Methods: The Surveillance, Epidemiology, and End Results (SEER)-Medicare records identified 3986 individuals aged 66 years or older diagnosed with stage III lung cancer between 2001 and 2007 and treated with IMRT or 3D conformal radiotherapy. Predictors of IMRT use were determined using logistic regression. Associations of IMRT use with diagnosis codes for radiation-related toxicities were evaluated with multivariate proportional hazards regression and propensity-score matching. Results: Among the 3986 patients studied, the median age was 75 years, 54.1% were male, and 62% had IIIA disease. Two hundred and fifty seven (6.5%) patients received IMRT, with use increasing from 0.5% in 2001 to 14.7% in 2007 (P< 0.001). Key predictors of IMRT delivery included increasing year of diagnosis and treatment in a freestanding center (odds ratio, 2.10; 95% confidence interval [CI], 1.59-2.77, P< 0.001); tumor size, stage, and number of radiotherapy fractions delivered were not associated with IMRT use. IMRT use was not associated with a higher burden of lung or esophagus toxicities when compared to 3DCRT. Conclusion: These findings suggest that practice environment strongly influenced adoption of IMRT for lung cancer. Patient and tumor factors were not significant predictors of IMRT use. Esophagus and lung toxicity rates were similar between IMRT and 3DCRT.
AB - Background: Intensity modulated radiotherapy for stage III lung cancer has become commonplace in the United States in the absence of randomized controlled trials. We used a large, population-based database to determine which factors led to increased utilization of IMRT and to evaluate associations of IMRT with toxicities. Methods: The Surveillance, Epidemiology, and End Results (SEER)-Medicare records identified 3986 individuals aged 66 years or older diagnosed with stage III lung cancer between 2001 and 2007 and treated with IMRT or 3D conformal radiotherapy. Predictors of IMRT use were determined using logistic regression. Associations of IMRT use with diagnosis codes for radiation-related toxicities were evaluated with multivariate proportional hazards regression and propensity-score matching. Results: Among the 3986 patients studied, the median age was 75 years, 54.1% were male, and 62% had IIIA disease. Two hundred and fifty seven (6.5%) patients received IMRT, with use increasing from 0.5% in 2001 to 14.7% in 2007 (P< 0.001). Key predictors of IMRT delivery included increasing year of diagnosis and treatment in a freestanding center (odds ratio, 2.10; 95% confidence interval [CI], 1.59-2.77, P< 0.001); tumor size, stage, and number of radiotherapy fractions delivered were not associated with IMRT use. IMRT use was not associated with a higher burden of lung or esophagus toxicities when compared to 3DCRT. Conclusion: These findings suggest that practice environment strongly influenced adoption of IMRT for lung cancer. Patient and tumor factors were not significant predictors of IMRT use. Esophagus and lung toxicity rates were similar between IMRT and 3DCRT.
KW - Comparative effectiveness
KW - IMRT
KW - Non-small cell lung cancer
KW - Radiation technique
KW - Technology utilization
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U2 - 10.1016/j.lungcan.2013.08.015
DO - 10.1016/j.lungcan.2013.08.015
M3 - Article
C2 - 24018022
AN - SCOPUS:84887022892
SN - 0169-5002
VL - 82
SP - 252
EP - 259
JO - Lung Cancer
JF - Lung Cancer
IS - 2
ER -