TY - JOUR
T1 - Factors Influencing Noncompletion of Radiation Therapy Among Men With Localized Prostate Cancer
AU - Dee, Edward Christopher
AU - Muralidhar, Vinayak
AU - Arega, Melaku A.
AU - Kishan, Amar U.
AU - Spratt, Daniel E.
AU - Dess, Robert T.
AU - King, Martin T.
AU - Sha, Sybil T.
AU - Santos, Patricia Mae G.
AU - Butler, Santino S.
AU - Sanford, Nina N.
AU - Nguyen, Paul L.
AU - Mahal, Brandon A.
N1 - Funding Information:
This research was funded by grant R01-CA240582 from the National Institutes of Health (P.L.N.), and the Prostate Cancer Foundation (B.A.M.), American Society for Radiation Oncology (B.A.M.), the Department of Defense (B.A.M.), and funds from the Sylvester Comprehensive Cancer Center (B.A.M.). Disclosures: B.A.M. receives funding from the Prostate Cancer Foundation (PCF), the American Society for Radiation Oncology (ASTRO), the Department of Defense, and the Sylvester Comprehensive Cancer Center, outside the submitted work. P.L.N. has received grants and personal fees from Bayer, Janssen, and Astellas and personal fees from Boston Scientific, Dendreon, Ferring, COTA, Blue Earth Diagnostics, and Augmenix, outside the submitted work. A.U.K. reports funding from ViewRay and Intelligent Automation and personal fees from Varian and Janssen, as well as research support from ASTRO, the PCF, and ViewRay, outside the submitted work. M.A.A. has received personal fees from Sarepta Therapeutics, outside the submitted work. V.M. received a grant from the Conquer Cancer Foundation, outside the submitted work. M.T.K. reports funding from Bayer and Palette Life Sciences, outside the submitted work. D.E.S. reports personal fees from Janssen, Blue Earth, and AstraZeneca, outside the submitted work.
Funding Information:
This research was funded by grant R01-CA240582 from the National Institutes of Health (P.L.N.), and the Prostate Cancer Foundation (B.A.M.), American Society for Radiation Oncology (B.A.M.), the Department of Defense (B.A.M.), and funds from the Sylvester Comprehensive Cancer Center (B.A.M.).
Funding Information:
Disclosures: B.A.M. receives funding from the Prostate Cancer Foundation (PCF), the American Society for Radiation Oncology (ASTRO), the Department of Defense, and the Sylvester Comprehensive Cancer Center, outside the submitted work. P.L.N. has received grants and personal fees from Bayer, Janssen, and Astellas and personal fees from Boston Scientific, Dendreon, Ferring, COTA, Blue Earth Diagnostics, and Augmenix, outside the submitted work. A.U.K. reports funding from ViewRay and Intelligent Automation and personal fees from Varian and Janssen, as well as research support from ASTRO, the PCF, and ViewRay, outside the submitted work. M.A.A. has received personal fees from Sarepta Therapeutics, outside the submitted work. V.M. received a grant from the Conquer Cancer Foundation, outside the submitted work. M.T.K. reports funding from Bayer and Palette Life Sciences, outside the submitted work. D.E.S. reports personal fees from Janssen, Blue Earth, and AstraZeneca, outside the submitted work.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - Purpose: Treatment noncompletion may occur with radiation therapy (RT), especially with protracted treatment courses such as RT for prostate cancer, and may affect the efficacy of RT. For men with localized prostate cancer managed with primary RT, we evaluated associations between rates of treatment noncompletion and RT fractionation schedules. Methods and Materials: The National Cancer Database identified men diagnosed from 2004 to 2014 treated with primary RT. Patients receiving 180 cGy/fraction or 200 cGy/fraction were defined as having completed radiation therapy if they received ≥41 fractions of 180 cGy/fraction or ≥37 fractions of 200 cGy/fraction. Stereotactic body radiation therapy (SBRT) was defined as 5 to 8 fractions of 600 to 800 cGy/fraction. Odds ratios compared rates of treatment noncompletion, adjusting for sociodemographic covariates. A propensity-adjusted multivariable Cox regression assessed the association between treatment completion and overall survival. Results: Of 157,657 patients, 95.7% (n = 150,847) received conventional fractionation and 4.3% (n = 6810) received SBRT. Rates of noncompletion were 12.5% (n = 18,803) among patients who received conventional fractionation and 1.9% (n = 131) among patients who received SBRT (odds ratio [OR] versus conventional, 0.21; 95% confidence interval [CI], 0.18-0.26; P < .001). The rate of noncompletion among 25,727 African American patients was 12.8%, compared with 11.8% among 126,199 white patients (OR, 1.14; 95% CI, 1.09-1.19; P < .001). In a subgroup analysis, the disparity in noncompletion persisted for conventional fractionation (13.2% vs 12.3%, respectively; OR, 1.09; 95% CI, 1.05-1.13; P < .001), but not for SBRT (2.2% vs 1.8%, respectively; OR, 1.26; 95% CI, 0.79-2.00; P = .34). Noncompletion was associated with worse survival in a propensity-adjusted multivariable analysis (hazard ratio, 1.25; 95% CI, 1.22-1.29; P < .001). Conclusions: SBRT was associated with lower rates of RT noncompletion among men with localized prostate cancer. African American race was associated with greater rates of treatment noncompletion, although the disparity may be decreased among men receiving SBRT.
AB - Purpose: Treatment noncompletion may occur with radiation therapy (RT), especially with protracted treatment courses such as RT for prostate cancer, and may affect the efficacy of RT. For men with localized prostate cancer managed with primary RT, we evaluated associations between rates of treatment noncompletion and RT fractionation schedules. Methods and Materials: The National Cancer Database identified men diagnosed from 2004 to 2014 treated with primary RT. Patients receiving 180 cGy/fraction or 200 cGy/fraction were defined as having completed radiation therapy if they received ≥41 fractions of 180 cGy/fraction or ≥37 fractions of 200 cGy/fraction. Stereotactic body radiation therapy (SBRT) was defined as 5 to 8 fractions of 600 to 800 cGy/fraction. Odds ratios compared rates of treatment noncompletion, adjusting for sociodemographic covariates. A propensity-adjusted multivariable Cox regression assessed the association between treatment completion and overall survival. Results: Of 157,657 patients, 95.7% (n = 150,847) received conventional fractionation and 4.3% (n = 6810) received SBRT. Rates of noncompletion were 12.5% (n = 18,803) among patients who received conventional fractionation and 1.9% (n = 131) among patients who received SBRT (odds ratio [OR] versus conventional, 0.21; 95% confidence interval [CI], 0.18-0.26; P < .001). The rate of noncompletion among 25,727 African American patients was 12.8%, compared with 11.8% among 126,199 white patients (OR, 1.14; 95% CI, 1.09-1.19; P < .001). In a subgroup analysis, the disparity in noncompletion persisted for conventional fractionation (13.2% vs 12.3%, respectively; OR, 1.09; 95% CI, 1.05-1.13; P < .001), but not for SBRT (2.2% vs 1.8%, respectively; OR, 1.26; 95% CI, 0.79-2.00; P = .34). Noncompletion was associated with worse survival in a propensity-adjusted multivariable analysis (hazard ratio, 1.25; 95% CI, 1.22-1.29; P < .001). Conclusions: SBRT was associated with lower rates of RT noncompletion among men with localized prostate cancer. African American race was associated with greater rates of treatment noncompletion, although the disparity may be decreased among men receiving SBRT.
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U2 - 10.1016/j.ijrobp.2020.11.064
DO - 10.1016/j.ijrobp.2020.11.064
M3 - Article
C2 - 33276019
AN - SCOPUS:85098665063
SN - 0360-3016
VL - 109
SP - 1279
EP - 1285
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 5
ER -