TY - JOUR
T1 - Impact of radiation therapy facility volume on survival in patients with cancer
AU - Tchelebi, Leila T.
AU - Shen, Biyi
AU - Wang, Ming
AU - Gusani, Niraj J.
AU - Walter, Vonn
AU - Abrams, Ross
AU - Verma, Vivek
AU - Zaorsky, Nicholas G.
N1 - Funding Information:
We have no financial conflicts of interests. Nicholas G. Zaorsky received start‐up funding from Penn State Cancer Institute, is supported by the National Institutes of Health LRP 1 L30 CA231572‐01, and also received personal fees, unrelated to the current work, from Springer Nature, Inc and Weatherby Healthcare. Dr Zaorsky is supported by the AmericanCancer Society – Tri State CEOs Against Cancer Clinician Scientist DevelopmentGrant, CSDG‐20‐013‐01‐CCE. There was no funding source for this project. No author received payment by a pharmaceutical company or other agency. All authors had full access to all data in the study and accept responsibility for publication.
Publisher Copyright:
© 2021 American Cancer Society
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Background: This study examined whether radiation therapy facility volumes correlate with survival after curative intent treatment of solid tumors. Methods: The National Cancer Database was queried for patients with solid tumors treated with curative-intent radiation therapy from 2004-2013. Facilities were stratified into 4 volume categories: low, intermediate, high, and very high. Primary cancer sites were divided into neoadjuvant, adjuvant, or definitive radiation subgroups. Kaplan-Meier curves of 5-year postradiation survival probability, stratified by facility volume, were generated with log-rank tests for group comparisons. Cox proportional hazard models were used to evaluate the effect of facility volume on survival, adjusted for multiple covariates. Results: There were 253,422 patients treated at 1289 facilities: 6231 received neoadjuvant radiation, 147,980 received adjuvant radiation, and 99,211 received definitive radiation without surgery. Among patients receiving neoadjuvant radiation, survival correlated with facility volume for patients with rectal cancer (hazard ratio [HR], 0.75; 95% CI, 0.6-0.94; P =.01). For cancers of the breast and uterus, patients receiving adjuvant radiation at very high-volume facilities (vs low volume) had improved survival (HR, 0.83; 95% CI, 0.77-0.90; P <.001 and HR, 0.77, 95% CI, 0.62-0.97; P =.03, respectively). For patients receiving definitive radiation for prostate, non–small cell lung, pancreas, and head and neck cancer, there was an improvement in survival for patients treated at very high-volume centers (P <.05). Conclusions: For select cancer patients, treatment with curative radiation at higher volume facilities is associated with improved survival. In particular, patients receiving radiation therapy in the definitive setting without surgery may benefit most from treatment at high-volume centers.
AB - Background: This study examined whether radiation therapy facility volumes correlate with survival after curative intent treatment of solid tumors. Methods: The National Cancer Database was queried for patients with solid tumors treated with curative-intent radiation therapy from 2004-2013. Facilities were stratified into 4 volume categories: low, intermediate, high, and very high. Primary cancer sites were divided into neoadjuvant, adjuvant, or definitive radiation subgroups. Kaplan-Meier curves of 5-year postradiation survival probability, stratified by facility volume, were generated with log-rank tests for group comparisons. Cox proportional hazard models were used to evaluate the effect of facility volume on survival, adjusted for multiple covariates. Results: There were 253,422 patients treated at 1289 facilities: 6231 received neoadjuvant radiation, 147,980 received adjuvant radiation, and 99,211 received definitive radiation without surgery. Among patients receiving neoadjuvant radiation, survival correlated with facility volume for patients with rectal cancer (hazard ratio [HR], 0.75; 95% CI, 0.6-0.94; P =.01). For cancers of the breast and uterus, patients receiving adjuvant radiation at very high-volume facilities (vs low volume) had improved survival (HR, 0.83; 95% CI, 0.77-0.90; P <.001 and HR, 0.77, 95% CI, 0.62-0.97; P =.03, respectively). For patients receiving definitive radiation for prostate, non–small cell lung, pancreas, and head and neck cancer, there was an improvement in survival for patients treated at very high-volume centers (P <.05). Conclusions: For select cancer patients, treatment with curative radiation at higher volume facilities is associated with improved survival. In particular, patients receiving radiation therapy in the definitive setting without surgery may benefit most from treatment at high-volume centers.
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U2 - 10.1002/cncr.33777
DO - 10.1002/cncr.33777
M3 - Article
C2 - 34398470
AN - SCOPUS:85112449346
SN - 0008-543X
VL - 127
SP - 4081
EP - 4090
JO - Cancer
JF - Cancer
IS - 21
ER -