Patterns of Care and Utilization Disparities in Proton Radiation Therapy for Pediatric Central Nervous System Malignancies

被引:5
作者
Weil, Christopher R. [1 ]
Lew, Felicia H. [2 ]
Williams, Vonetta M. [3 ]
Burt, Lindsay M. [1 ]
Ermoian, Ralph P. [3 ]
Poppe, Matthew M. [1 ]
机构
[1] Univ Utah, Huntsman Canc Inst, Dept Radiat Oncol, Salt Lake City, UT 84112 USA
[2] Washington State Univ, Elson S Floyd Coll Med, Spokane, WA USA
[3] Univ Washington, Dept Radiat Oncol, Seattle, WA USA
关键词
CLINICAL-OUTCOMES; COST-EFFECTIVENESS; RADIOTHERAPY; TUMORS; CHILDREN; BRAIN;
D O I
10.1016/j.adro.2021.100868
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Proton radiation therapy (PR) is well established in the treatment of pediatric malignancies in the central nervous system (CNS) with dosimetric advantages that reduce late radiation therapy (RT) effects. In this analysis, we sought to evaluate the utilization of PR in children with primary CNS malignancies and characterize the clinical and sociodemographic factors predictive of receipt of PR.Methods and Materials: The National Cancer Database was queried to identify all pediatric patients with primary CNS malignancies treated with curative intent RT from 2004 to 2017. Clinical characteristics and demographics were analyzed using standard t and x2 testing. Predictors of PR receipt were identified with univariable and multivariable logistic regression.Results: We identified 9126 patients <= 18 years of age treated with RT between 2004 and 2017, of which 1045 (11.5%) received PR. PR usage continued to increase significantly, from <1% in 2004 to 28% in 2017. The proportion of white and Asian patients receiving PR for nonhigh-grade glioma and nonmeningioma CNS malignancies during the study period rose from <1% for both to 35% and 44%, respectively, and in black patients the proportion rose from <1% to 26%. Multivariable predictors of receipt of PR include year of diagnosis, age <6 years, income level, distance from PR facility, and histology; multivariable predictors of receipt of photon RT include black race, rural residence, and Medicaid insurance. These factors remained significant when isolating the most recent 5 years of data.Conclusions: Proton radiation therapy usage for CNS malignancies increased significantly during the study period. Despite the potential clinical advantages of PR for pediatric primary CNS malignancies, there are notable socioeconomic, geographic, and racial disparities in the receipt of PR that persisted despite the increased availability and accessibility. Further study is warranted to identify how to address the disparities and better support these patients.(c) 2022 The Authors. Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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页数:8
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