Receipt of EBRT for CTCL varies by sociodemographic factors and the centers where patients receive their care. Among those receiving EBRT, there are variations in dose, and median survival may vary by race. Further research is needed to assess differences in receipt, outcomes, and dose.
Debra Yeboa, MD, Sanjay Anejea, MD, Lynn D. Wilson, MD, MPH; Yale University
OBJECTIVE: We assessed receipt and patterns of care for patients diagnosed with cutaneous T-cell lymphoma (CTCL) treated with external beam radiation therapy (EBRT) vs no radiation.
METHODS: Using the National Cancer Data Base, we identified 9,053 adult patients with CTCL (mycosis fungoides, primary cutaneous CD30+ lymphoma, or other CTCL) diagnosed from 2004 to 2013 who received either EBRT or no radiation to the skin. Univariable and multivariable logistic regression analyses were performed to assess factors associated with EBRT utilization. Covariates included age, sex, race, sociodemographic factors, facility type, diagnosis year, comorbidity, and stage. To assess median overall survival (OS), Kaplan-Meier estimates were performed.
RESULTS: Among our cohort, 7,171 patients received no RT vs 1,882 patients receiving EBRT to the skin. On univariate analysis, receipt of EBRT was associated with older age, higher income, insurance, treatment at a comprehensive cancer center, and cancer stage, while lower likelihood of receipt was associated with female sex and black or Asian race. In the multivariable logistic regression, receipt of EBRT was most associated with higher income (> $62,000; odds ratio [OR], 1.27 [95% CI, 1.05–1.53]; P = .011), diagnosis at a comprehensive cancer center (OR, 1.33 [95% CI, 1.06–1.68]; P = .013), and stage II disease (OR, 2.24 [95% CI, 1.87–2.69]; P < .001). Lower likelihood of receipt of EBRT was associated with female sex (OR, 0.80 [95% CI, 0.71–0.90]; P < .001), black race (OR, 0.62 [95% CI, 0.51–0.75]; P < .001), and Asian race (OR, 0.60 [95% CI, 0.38–0.95]; P < .031). Among 1,882 patients receiving RT, frequent cumulative doses were 30 Gy (19.6%) and 36 Gy (17.7%), with wide variation. Among those receiving EBRT, median survival varied nonsignificantly by race (white, 10.3 yr; black, 8.7 yr; and Asian, 8.6 yr).
CONCLUSION: Receipt of EBRT for CTCL varies by sociodemographic factors and the centers where patients receive their care. Among those receiving EBRT, there are variations in dose, and median survival may vary by race. Further research is needed to assess differences in receipt, outcomes, and dose.
Proceedings of the 98th Annual Meeting of the American Radium Society -americanradiumsociety.org