Hematologic Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_43_2783 - Higher Volume Facilities are Associated With the Delivery of Lower Dose Radiation Therapy in the Treatment of Cutaneous T-Cell Lymphoma

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

Higher Volume Facilities are Associated With the Delivery of Lower Dose Radiation Therapy in the Treatment of Cutaneous T-Cell Lymphoma
J. A. Miccio1, L. D. Wilson2, B. H. Kann1, V. Jairam3, J. M. Beckta2, and D. N. Yeboa4; 1Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, 2Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, 3Yale School of Medicine, New Haven, CT, 4MD Anderson Cancer Center, Houston, TX

Purpose/Objective(s): Radiotherapy (RT) is an effective treatment for Cutaneous T-Cell Lymphoma (CTCL) in various stages of the disease, ranging from localized therapy treating symptomatic lesions to total skin electron beam therapy (TSEBT) for more diffuse skin involvement. Beginning in 2011, there have been several studies advocating for low dose RT for CTCL patients (<30 Gy) given similar response rates and less toxicity as compared to higher dose (≥30 Gy). We retrospectively evaluated trends in RT dose and analyzed predictors associated with the delivery of low dose RT.

Materials/Methods: We identified 2,108 adult patients with CTCL in the National Cancer Database diagnosed from 2004 to 2015 using histology codes of primary CTCL, mycosis fungoides, or CD 30+ T-Cell lymphoma who received external beam RT to the skin only. Univariate and multivariable logistic regression models were created to evaluate predictors of low dose RT as compared to high dose. Covariates included age, sex, race, comorbidity (Charlson-Deyo comorbidity score CDCS), sociodemographic factors, year of diagnosis, stage, therapy received, facility type, and facility volume. The facility volume was determined by the average number of patients treated annually at each of the facilities in the NCDB that treated at least one CTCL patient with RT from 2004-2015. The facilities were then grouped together by quintiles of average number of patients treated per year. Analysis was performed using STATA v13.

Results: In all years of diagnosis, most patients received high dose RT (average annual percentage receiving high dose vs. low dose, 77.6% vs. 22.4%). The annual percentage of patients receiving high dose RT was stable from 2004-2012, but decreased dramatically from 80.3% in 2012 to 61.6% in 2015. A later year of diagnosis was associated with receipt of low dose RT (2014 vs. 2004, OR 2.27, 95% CI 1.35 – 3.82 and 2015 vs. 2004, OR 2.28, 95% CI 1.38 – 3.78). Six hundred forty-three NCDB-coding facilities treated at least one CTCL patient with RT between 2004-2015. Based on the average number of patients treated annually, the highest (1st) quintile of facility volume was determined to be >2 patients annually. Treatment at a high-volume facility was associated with receipt of low dose RT (1st quintile vs. 2-5th quintiles, OR 1.37, 95% CI 1.04 – 1.81)

Conclusion: Despite past literature showing adequate disease control with RT doses <30Gy, the majority of CTCL patients are still receiving RT doses ≥30 Gy. Patients diagnosed after 2013 were more likely to receive low dose RT. Facilities that treated ≥2 patients annually with RT had more adoption of lower dose RT.

Author Disclosure: J.A. Miccio: None. L.D. Wilson: Stock; Vertex, Immunogen, United Healthcare, UCAN, CBLI, Glaxo, Novart, Amgen, Biogen, ISIS, Merck. Royalty; Jones and Bartlett. Trustee; ABR. Professor/VC/Clinical Director; Yale University. B.H. Kann: None. D.N. Yeboa: Travel Expenses; Eli Lilly.

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