Association of radiation dose intensity with overall survival in patients with distant metastases
Abstract Background Patients with metastatic cancer referred to radiation oncology have diverse prognoses and there is significant interest in personalizing treatment. We hypothesized that patients selected for higher biologically equivalent doses have improved overall survival. Methods The study po...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-11-01
|
| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.4304 |
| _version_ | 1823960798511235072 |
|---|---|
| author | Johnny Kao Mark K. Farrugia Samantha Frontario Amanda Zucker Emily Copel John Loscalzo Ashish Sangal Boramir Darakchiev Anurag Singh Symeon Missios |
| author_facet | Johnny Kao Mark K. Farrugia Samantha Frontario Amanda Zucker Emily Copel John Loscalzo Ashish Sangal Boramir Darakchiev Anurag Singh Symeon Missios |
| author_sort | Johnny Kao |
| collection | DOAJ |
| description | Abstract Background Patients with metastatic cancer referred to radiation oncology have diverse prognoses and there is significant interest in personalizing treatment. We hypothesized that patients selected for higher biologically equivalent doses have improved overall survival. Methods The study population consists of 355 consecutive adult patients with distant metastases treated by a single radiation oncologist from 2014 to 2018. The validated NEAT model was used to prospectively stratify patients into four distinct cohorts. Radiation dose intensity was standardized using the equivalent dose in 2 Gy fractions (EQD2) model with an α/β of 10. Radiation dose intensity on survival was assessed via Cox regression models and propensity score match pairing with Kaplan–Meier analysis. Results The median survival was 9.3 months and the median follow‐up for surviving patients was 18.3 months. The NEAT model cohorts indicated median survivals of 29.5, 11.8, 4.9, and 1.8 months. Patients receiving an EQD2 of ≥40 Gy had a median survival of 16.0 months versus 3.8 months for patients receiving an EQD2 of <40 Gy (p < 0.001). On multivariable analysis, performance status, primary tumor site, radiation dose intensity, albumin, liver metastases, and number of active tumors were all independent predictors of survival (p < 0.05 for all). Propensity score matching was performed for performance status, albumin, number of active tumors, primary tumor site, and liver metastasis, finding higher EQD2 to remain significantly associated with improved survival within the matched cohort (p = 0.004). Conclusion Higher radiation dose intensity was used in patients with better prognosis and was associated with improved survival for patients with metastatic disease. |
| first_indexed | 2024-12-17T16:54:53Z |
| format | Article |
| id | doaj.art-b60aae74b41344d391e385811cd109f8 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-12-17T16:54:53Z |
| publishDate | 2021-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-b60aae74b41344d391e385811cd109f82022-12-21T21:40:30ZengWileyCancer Medicine2045-76342021-11-0110227934794210.1002/cam4.4304Association of radiation dose intensity with overall survival in patients with distant metastasesJohnny Kao0Mark K. Farrugia1Samantha Frontario2Amanda Zucker3Emily Copel4John Loscalzo5Ashish Sangal6Boramir Darakchiev7Anurag Singh8Symeon Missios9Department of Radiation Oncology Good Samaritan Hospital Medical Center West Islip New York USADepartment of Radiation Medicine, Roswell Park Cancer Institute Buffalo New York USAThe Cancer Institute at Good Samaritan West Islip New York USADepartment of Radiation Oncology Good Samaritan Hospital Medical Center West Islip New York USAThe Cancer Institute at Good Samaritan West Islip New York USAThe Cancer Institute at Good Samaritan West Islip New York USAThe Cancer Institute at Good Samaritan West Islip New York USAThe Cancer Institute at Good Samaritan West Islip New York USADepartment of Radiation Medicine, Roswell Park Cancer Institute Buffalo New York USAThe Cancer Institute at Good Samaritan West Islip New York USAAbstract Background Patients with metastatic cancer referred to radiation oncology have diverse prognoses and there is significant interest in personalizing treatment. We hypothesized that patients selected for higher biologically equivalent doses have improved overall survival. Methods The study population consists of 355 consecutive adult patients with distant metastases treated by a single radiation oncologist from 2014 to 2018. The validated NEAT model was used to prospectively stratify patients into four distinct cohorts. Radiation dose intensity was standardized using the equivalent dose in 2 Gy fractions (EQD2) model with an α/β of 10. Radiation dose intensity on survival was assessed via Cox regression models and propensity score match pairing with Kaplan–Meier analysis. Results The median survival was 9.3 months and the median follow‐up for surviving patients was 18.3 months. The NEAT model cohorts indicated median survivals of 29.5, 11.8, 4.9, and 1.8 months. Patients receiving an EQD2 of ≥40 Gy had a median survival of 16.0 months versus 3.8 months for patients receiving an EQD2 of <40 Gy (p < 0.001). On multivariable analysis, performance status, primary tumor site, radiation dose intensity, albumin, liver metastases, and number of active tumors were all independent predictors of survival (p < 0.05 for all). Propensity score matching was performed for performance status, albumin, number of active tumors, primary tumor site, and liver metastasis, finding higher EQD2 to remain significantly associated with improved survival within the matched cohort (p = 0.004). Conclusion Higher radiation dose intensity was used in patients with better prognosis and was associated with improved survival for patients with metastatic disease.https://doi.org/10.1002/cam4.4304metastaticpatient selectionradiotherapysurvival |
| spellingShingle | Johnny Kao Mark K. Farrugia Samantha Frontario Amanda Zucker Emily Copel John Loscalzo Ashish Sangal Boramir Darakchiev Anurag Singh Symeon Missios Association of radiation dose intensity with overall survival in patients with distant metastases Cancer Medicine metastatic patient selection radiotherapy survival |
| title | Association of radiation dose intensity with overall survival in patients with distant metastases |
| title_full | Association of radiation dose intensity with overall survival in patients with distant metastases |
| title_fullStr | Association of radiation dose intensity with overall survival in patients with distant metastases |
| title_full_unstemmed | Association of radiation dose intensity with overall survival in patients with distant metastases |
| title_short | Association of radiation dose intensity with overall survival in patients with distant metastases |
| title_sort | association of radiation dose intensity with overall survival in patients with distant metastases |
| topic | metastatic patient selection radiotherapy survival |
| url | https://doi.org/10.1002/cam4.4304 |
| work_keys_str_mv | AT johnnykao associationofradiationdoseintensitywithoverallsurvivalinpatientswithdistantmetastases AT markkfarrugia associationofradiationdoseintensitywithoverallsurvivalinpatientswithdistantmetastases AT samanthafrontario associationofradiationdoseintensitywithoverallsurvivalinpatientswithdistantmetastases AT amandazucker associationofradiationdoseintensitywithoverallsurvivalinpatientswithdistantmetastases AT emilycopel associationofradiationdoseintensitywithoverallsurvivalinpatientswithdistantmetastases AT johnloscalzo associationofradiationdoseintensitywithoverallsurvivalinpatientswithdistantmetastases AT ashishsangal associationofradiationdoseintensitywithoverallsurvivalinpatientswithdistantmetastases AT boramirdarakchiev associationofradiationdoseintensitywithoverallsurvivalinpatientswithdistantmetastases AT anuragsingh associationofradiationdoseintensitywithoverallsurvivalinpatientswithdistantmetastases AT symeonmissios associationofradiationdoseintensitywithoverallsurvivalinpatientswithdistantmetastases |