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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Oncol. | doi: 10.3389/fonc.2018.00440

Proton Versus Photon Radiation Therapy for Primary Gliomas: An Analysis of the National Cancer Data Base

 Jaymin Jhaveri1, 2*, En Cheng3, Zachary S. Buchwald1, 2, Mudit Chowdhary4, Yuan Liu2, Theresa W. Gillespie2, Jeffrey J. Olson1, 2, Bree R. Eaton1, 2, Hui-Kuo G. Shu1, 2, Ian R. Crocker1, 2, Mark W. McDonald1, 2, Walter J. Curran1, 2 and Kirtesh R. Patel5
  • 1Emory University School of Medicine, United States
  • 2Winship Cancer Institute, Emory University, United States
  • 3Rollins School of Public Health, Emory University, United States
  • 4Rush University Medical Center, United States
  • 5Yale School of Medicine, Yale University, United States

BACKGROUND: To investigate the impact of proton radiotherapy (PBT) on overall survival (OS) and evaluate PBT usage trends for patients with gliomas in the National Cancer Data Base (NCDB).
METHODS: Patients with a diagnosis of World Health Organization (WHO) Grade I-IV glioma treated with definitive radiation therapy (RT) between the years of 2004-13 were identified. Patients were stratified based on WHO Grade and photon radiotherapy (XRT) versus PBT. Univariate (UVA) and multivariable analysis (MVA) with OS were performed by Cox proportional hazards model and log-rank tests. Propensity score (PS) weighting was utilized to account for differences in patient characteristics and to minimize selection bias.
RESULTS: There were a total of 49,405 patients treated with XRT and 170 patients treated with PBT. Median follow-up time was 62.1 months. On MVA, the following factors were associated with receipt of PBT (all p < 0.05): WHO Grade I-II gliomas, treatment at an academic/research program, west geographic facility location, and surgical resection. After PS weighting, all patients treated with PBT were found to have superior median and 5-year survival than patients treated with XRT: 45.9 vs. 29.7 months (p = 0.009) and 46.1% vs. 35.5% (p = 0.0160), respectively.
CONCLUSIONS: PBT is associated with improved OS compared to XRT for patients with gliomas. This finding warrants verification in the randomized trial setting in order to account for potential patient imbalances not adequately captured by the NCDB, such as tumor molecular characteristics and patient performance status.

Keywords: Glioma, Proton radiotherapy, NCDB = National Cancer Data Base, Survival, proton, Radiation

Received: 18 Jul 2018; Accepted: 20 Sep 2018.

Edited by:

Brian T. Collins, School of Medicine, Georgetown University, United States

Reviewed by:

DANIEL HAMSTRA, University of Michigan, United States
Young Kwok, University of Maryland Medical Center, United States  

Copyright: © 2018 Jhaveri, Cheng, Buchwald, Chowdhary, Liu, Gillespie, Olson, Eaton, Shu, Crocker, McDonald, Curran and Patel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD. Jaymin Jhaveri, Emory University School of Medicine, Atlanta, United States,