Prospective Evaluation of Limited-Stage Small Cell Lung Cancer Radiotherapy Fractionation Regimen Usage and Acute Toxicity in a Large Statewide Quality Collaborative.

Autor:	Allen SG; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Dragovic AF; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Yin HM; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan., Bryant AK; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Paximadis PA; Department of Radiation Oncology, Spectrum Health Lakeland, St. Joseph, Michigan., Matuszak MM; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Schipper MJ; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan., Dess RT; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Hayman JA; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Dominello MM; Department of Radiation Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan., Kestin LL; Michigan Healthcare Professionals, 21st Century Oncology, Farmington Hills, Michigan., Movsas B; Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan., Jolly S; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: shrutij@med.umich.edu., Bergsma DP; Department of Radiation Oncology, Mercy Health Saint Mary's, Grand Rapids, Michigan. Electronic address: bergsmad@med.umich.edu.
Jazyk:	angličtina
Zdroj:	Practical radiation oncology [Pract Radiat Oncol] 2023 Sep-Oct; Vol. 13 (5), pp. 444-453. Date of Electronic Publication: 2023 Apr 24.
DOI:	10.1016/j.prro.2023.04.007
Abstrakt:	Purpose: National guidelines on limited-stage small cell lung cancer (LS-SCLC) treatment give preference to a hyperfractionated regimen of 45 Gy in 30 fractions delivered twice daily; however, use of this regimen is uncommon compared with once-daily regimens. The purpose of this study was to characterize the LS-SCLC fractionation regimens used throughout a statewide collaborative, analyze patient and treatment factors associated with these regimens, and describe real-world acute toxicity profiles of once- and twice-daily radiation therapy (RT) regimens. Methods and Materials: Demographic, clinical, and treatment data along with physician-assessed toxicity and patient-reported outcomes were prospectively collected by 29 institutions within the Michigan Radiation Oncology Quality Consortium between 2012 and 2021 for patients with LS-SCLC. We modeled the influence of RT fractionation and other patient-level variables clustered by treatment site on the odds of a treatment break specifically due to toxicity with multilevel logistic regression. National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0, incident grade 2 or worse toxicity was longitudinally compared between regimens. Results: There were 78 patients (15.6% overall) treated with twice-daily RT and 421 patients treated with once-daily RT. Patients receiving twice-daily RT were more likely to be married or living with someone (65% vs 51%; P = .019) and to have no major comorbidities (24% vs 10%; P = .017). Once-daily RT fractionation toxicity peaked during RT, and twice-daily toxicity peaked within 1 month after RT. After stratifying by treatment site and adjusting for patient-level variables, once-daily treated patients had 4.11 (95% confidence interval, 1.31-12.87) higher odds of treatment break specifically due to toxicity than twice-daily treated patients. Conclusions: Hyperfractionation for LS-SCLC remains infrequently prescribed despite the lack of evidence demonstrating superior efficacy or lower toxicity of once-daily RT. With peak acute toxicity after RT and lower likelihood of a treatment break with twice-daily fractionation in real-word practice, providers may start using hyperfractionated RT more frequently. (Copyright © 2023 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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