Travel distance and stereotactic body radiotherapy for localized prostate cancer

Mahal, Brandon A.; Chen, Yu-Wei; Sethi, Roshan V.; Padilla, Oscar; Yang, David D.; Chavez, Janice; Muralidhar, Vinayak; Hu, Jim C.; Feng, Felix Y.; Hoffman, Karen E.; Martin, Neil E.; Spratt, Daniel E.; Yu, James B.; Orio, Peter F.; Nguyen, Paul L.

doi:10.1002/cncr.31190

Cited by 24 publications

(19 citation statements)

References 30 publications

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“…Lack of insurance, lack of access to an automobile or someone to drive patients to treatment, and financial toxicity as well as cultural beliefs regarding health care have been shown to contribute toward racial and ethnic differences in travel patterns. [22][23][24] The results of the current study generally are in agreement, because we also observed that certain social determinants of health (insurance, education, and income) contributed toward low rates of traveling long distances for HNSCC care in African American and Hispanic patients. Two exceptions included the finding that higher educational attainment at census tract quartile levels was inversely associated with a higher likelihood of long travel distance in African American patients and that lower census tract income quartiles were not associated with decreased odds of traveling longer for HNSCC care.…”

Section: Discussionsupporting

confidence: 85%

Racial and Ethnic Disparities in Travel for Head and Neck Cancer Treatment and the Impact of Travel Distance on Survival

Graboyes

Ellis

et al. 2018

Cancer

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BACKGROUND Patients who travel a long distance (≥50 miles) for cancer care have improved outcomes. However, to the authors’ knowledge, the prevalence of long travel distances for treatment by patients with head and neck squamous cell carcinoma (HNSCC), and the effect of travel distance on overall survival (OS), remains unknown. METHODS The authors used the National Cancer Data base from 2004 through 2013 to identify patients with HNSCC undergoing definitive treatment. Travel distance for treatment was categorized as short (<12.5 miles), intermediate (12.5-49.9 miles), and long (50-249.9 miles). The primary outcome, OS, was evaluated using Cox shared-frailty modeling. A secondary outcome, factors associated with intermediate and long travel distances, was evaluated using multivariable hierarchical logistic regression. RESULTS Among 118,000 patients with HNSCC, 62,753 (53.2%), 40,644 (34.4%), and 14,603 (12.4%) patients, respectively, traveled short, intermediate, and long distances for treatment. After adjusting for relevant covariates, long travel distance was associated with treatment at academic and high-volume centers. Patients of black race, of Hispanic ethnicity, with Medicaid insurance, and who were treated with nonsurgical treatment were less likely to travel long distances for treatment (P<.001). Traveling a long distance for treatment was associated with improved OS on multivariable analysis (adjusted hazard ratio, 0.93; 95% confidence interval, 0.89-0.96) compared with a short distance. CONCLUSIONS Traveling a long distance for HNSCC treatment is associated with improved survival, especially for patients receiving nonsurgical management. Racial and ethnic disparities in travel for HNSCC treatment exist. As regionalization of care continues, future work should identify and address reasons for racial and ethnic disparities in travel that may prevent access to care at high-volume facilities.

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Section: Discussionsupporting

confidence: 85%

Racial and Ethnic Disparities in Travel for Head and Neck Cancer Treatment and the Impact of Travel Distance on Survival

Graboyes

Ellis

et al. 2018

Cancer

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“…Extreme hypofractionation using stereotactic body radiotherapy (SBRT) for localized prostate cancer (PCa) is recognized as an appropriate treatment option with a favorable toxicity profile for men with localized low-to intermediate-risk PCa (1)(2)(3)(4)(5). Current utilization trends indicate an uptake in SBRT adoption (6,7), which will likely be increased with dissemination of long-term safety data from the HYPO-RT-PC trial and acute toxicity information from the PACE-B trial (1,5). By definition, SBRT necessitates a high level of accuracy and precision during treatment delivery, as each fraction is responsible for delivering a high proportion of the total prescription dose (2,3).…”

Section: Introductionmentioning

confidence: 99%

Clinical Assessment of Prostate Displacement and Planning Target Volume Margins for Stereotactic Body Radiotherapy of Prostate Cancer

et al. 2020

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Purpose: To assess the optimal planning target volume (PTV) margins for stereotactic body radiotherapy (SBRT) of prostate cancer based on inter-and intra-fractional prostate motion determined from daily image guidance. Methods and Materials: Two hundred and five patients who were enrolled on two prospective studies of SBRT (8 Gy × 5 fractions) for localized prostate cancer treated at a single institution between 2012 and 2017 had complete inter-and intra-fractional shift data available. All patients had scheduled kilovoltage planar imaging during SBRT with rigid registration to intraprostatic fiducials prior to each of four half-arcs delivered per fraction, as well as cone beam CT verification of anatomy prior to each fraction. Inter-and intra-fractional shift data were obtained to estimate the required PTV margins based on the classic van Herk formula. Inter-and intra-fractional motion were compared between patients with and without severe toxicities using the independent two-sample Wilcoxon test. Results: The margins required to account for inter-fractional motion were estimated to be 0.99, 1.52, and 1.45 cm in lateral (LR), longitudinal (SI), and vertical (AP) directions, respectively. The margins required to account for intra-fractional motion were estimated to be 0.19, 0.27, and 0.31 cm in LR, SI and AP directions, respectively. Large intra-fractional shifts were mostly observed in the SI and AP directions, with 2.0 and 5.4% of patients experiencing average intra-fractional motion >3 mm in the SI and AP directions, respectively, compared with none experiencing mean shifts >3 mm in the LR direction. Six patients experienced grade 3 gastrointestinal or genitourinary toxicity. There were no significant differences in mean inter-or intra-fractional motion in any of the cardinal directions compared to patients without severe toxicity (inter-fractional p = 0.46-0.99, intra-fractional p = 0.10-0.84). Levin-Epstein et al. Prostate Displacement and SBRT Margins Conclusion: The inter-and intra-fractional margins estimated from this study are in line with prior reported values. Intra-fractional prostate motion was generally small with larger margins required for the SI and AP directions, notably just slightly exceeding the commonly used 3 mm posterior PTV margin even with realignment between half-arcs. Development of severe toxicity was not significantly associated with the degree of inter-or intra-fractional motion.

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“…While the inclusion of SBRT cases may have affected our results, the number of patients receiving SBRT relative to standard EBRT during our study's time period is small (3.8% vs. 96.2%). 19 Finally, we are unable to account for the field size used during nodal radiation and there could be significant variation that we cannot report.…”

Section: Discussionmentioning

confidence: 93%

National practice patterns for lymph node irradiation in 197,000 men receiving external beam radiotherapy for localized prostate cancer

Weiner

Zhu

et al. 2019

Urologic Oncology: Seminars and Original Investigations

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Purpose-Controversy surrounds the benefit of pelvic lymph node irradiation (PLN-RT) in localized prostate cancer (PCa). Our objective was to determine the practice patterns and predictors of PLN-RT in a national cohort. Materials and methods-The National Cancer Data Base (2005-2015) was leveraged to obtain men diagnosed with non-metastatic PCa treated with external beam radiotherapy (EBRT; n= 197,378). Multivariable logistic regressions were used to assess temporal trends and factors associated with PLN-RT. Results-PLN-RT occurred in 37% of patients overall, which increased to 41% by 2015. When stratified by risk-group, there was no significant difference in PLN-RT over time in low, favorable intermediate, unfavorable intermediate, or high-risk PCa. PLN-RT increased for men with very high-risk disease (51% to 60%; odds ratio per year 1.34, 95% CI 1.06-1.70, p=0.013). Increased odds of PLN-RT was associated with higher risk disease, addition of hormone therapy, treatment at community hospitals, and shorter patient travel distance to treatment facilities. Surprisingly, 26% and 34% of low and favorable intermediate risk PCa received PLN-RT, respectively. Predictors of PLN-RT among these patients included treatment at a community practice and use of brachytherapy or hormone therapy.

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Travel distance and stereotactic body radiotherapy for localized prostate cancer

Cited by 24 publications

References 30 publications

Racial and Ethnic Disparities in Travel for Head and Neck Cancer Treatment and the Impact of Travel Distance on Survival

Racial and Ethnic Disparities in Travel for Head and Neck Cancer Treatment and the Impact of Travel Distance on Survival

Clinical Assessment of Prostate Displacement and Planning Target Volume Margins for Stereotactic Body Radiotherapy of Prostate Cancer

National practice patterns for lymph node irradiation in 197,000 men receiving external beam radiotherapy for localized prostate cancer

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