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...

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Autores principales:	Johnny Kao, Mark K. Farrugia, Samantha Frontario, Amanda Zucker, Emily Copel, John Loscalzo, Ashish Sangal, Boramir Darakchiev, Anurag Singh, Symeon Missios
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	metastatic patient selection radiotherapy survival Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/b60aae74b41344d391e385811cd109f8
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spelling	oai:doaj.org-article:b60aae74b41344d391e385811cd109f82021-11-22T09:08:47ZAssociation of radiation dose intensity with overall survival in patients with distant metastases2045-763410.1002/cam4.4304https://doaj.org/article/b60aae74b41344d391e385811cd109f82021-11-01T00:00:00Zhttps://doi.org/10.1002/cam4.4304https://doaj.org/toc/2045-7634Abstract 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.Johnny KaoMark K. FarrugiaSamantha FrontarioAmanda ZuckerEmily CopelJohn LoscalzoAshish SangalBoramir DarakchievAnurag SinghSymeon MissiosWileyarticlemetastaticpatient selectionradiotherapysurvivalNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancer Medicine, Vol 10, Iss 22, Pp 7934-7942 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	metastatic patient selection radiotherapy survival Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	metastatic patient selection radiotherapy survival Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 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
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.
format	article
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
title	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_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_sort	association of radiation dose intensity with overall survival in patients with distant metastases
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/b60aae74b41344d391e385811cd109f8
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Association of radiation dose intensity with overall survival in patients with distant metastases

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