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MO_14_2819 - Comparative Utilization Analysis of Radiation Modalities Among Adults with Primary Brain Tumors in the United States from 2004 to 2015

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Comparative Utilization Analysis of Radiation Modalities Among Adults with Primary Brain Tumors in the United States from 2004 to 2015
E. M. Marchan1, A. C. Harrell2, M. R. Waddle1, R. C. Miller1, D. Miller3, W. Stross1, T. Kaleem1, H. Ruiz-Garcia1, J. L. Peterson4, A. Quinones-Hinojosa4, and D. M. Trifiletti4; 1Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, 2Mayo Clinic, Department of Radiation Oncology, Jacksonville, FL, 3Mayo Clinic, Jacksonville, FL, 4Department of Neurosurgery, Mayo Clinic, Jacksonville, FL

Purpose/Objective(s): External beam radiotherapy (EBRT) and stereotactic radiosurgery (SRS) are the main radiation modalities for adults with primary brain tumors (APBT). Since the early 2000s, new technologies such as intensity-modulated radiotherapy (IMRT), and most recently, proton beam therapy (PBT) have been commercialized for the treatment of these lesions. We sought to characterize the radiation treatment modality utilization trends over an 11-year period in a large population of APBT patients obtained from the National Cancer Database (NCDB). We hypothesized that there would be a significant increase in IMRT, SRS, and PBT utilization with a comparable decrease in conformal EBRT over time.

Materials/Methods: A retrospective cohort analysis was conducted of the NCDB to evaluate the characteristics of APBT who received radiation therapy from 2004-2015. The radiation treatment modalities were grouped into conformal EBRT, IMRT, SRS, PBT, other radiation, and no-radiation therapy. Conformal EBRT was defined as any 2D, 3D conformal radiotherapy, or external beam not-otherwise specified. We divided each of the radiation treatment modalities into two groups: regional treatment and boost treatment. Statistical analysis incorporating odds ratios (ORs) were performed. ORs over or under 1.0 signified that the odds of receiving that treatment increased or decreased from 2004-2015, respectively.

Results: A total of 223,404 APBT in the NCDB were evaluated from 2004-2015. The following modalities had significant increases in their utilization: IMRT regional (4.8% to 27.8%, OR: 1.158, p<0.001), IMRT boost (2.2% to 11.6%, OR: 1.137, p<0.001), PBT regional (0.2% to 1.5%, OR: 1.259, p<0.001), PBT boost (0% to 0.6%, OR: 1.465, p<0.001), and no-radiation therapy boost (75.6% to 76.3%, OR: 1.003, p=0.031). In contrast, the following modalities had significant decreases in their utilization: EBRT regional (45.3% to 24.8%, OR: 0.958, p<0.001), EBRT boost (17.5% to 8.1%, OR: 0.941, p<0.001), SRS regional (1.7% to 1%, OR: 0.949, p<0.001), SRS boost (0.3% to 0.1%, OR: 0.925, p<0.001), and no-radiation therapy regional (44.9% to 42.5%, OR: 0.992, p<0.001).

Conclusion: Our data illustrates a greater than five-fold increase in utilization of IMRT as a well a steady decrease in conformal EBRT in the treatment of APBT for both the regional and boost treatment groups over this 11-year span. While utilization for PBT (regional and boost) and SRS (regional and boost) significantly increased and decreased, respectively, their overall impact on current APBT resource utilization, when compared to IMRT, is small. It remains to be seen whether these changes will continue as society moves toward accountable care organizations, bundled payments, and value-based reimbursements.

Author Disclosure: E.M. Marchan: Member Board of Directors; Medical Association of Georgia. A.C. Harrell: None. M.R. Waddle: None. R.C. Miller: Consultant; Tekcapital, Plc, ASTRO, Belluscura Ltd. Stock; Belluscura Ltd, Tekcapital Plc. Stock Options; Belluscura Ltd, Tekcapital Plc. Vice Chair, Board of Trustees; Mayo Clinic Health System - Albert Lea/Austin. Chair, Board of Directors; Belluscura, Ltd. Non-Executive Director; Tekcapital, Plc. D. Miller: None. H. Ruiz-Garcia: None. J.L. Peterson: None. A. Quinones-Hinojosa: Chairman, Department of Neurosurgery; Mayo Clinic Jacksonville. D.M. Trifiletti: Member; ARRO.

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