Abstract
BACKGROUND: There is an increased interest in using proton beam radiation therapy (PBT) in Central nervous system (CNS) tumors. However, no clear information exists about the association of PBT with the overall survival (OS) of patients diagnosed with CNS tumors. The current study aims to investigate the association of PBT with the OS of patients with CNS tumors. METHODS: This study included patients from the National Cancer Database diagnosed with CNS tumors between 2004 and 2022. Multivariable Cox regression analysis was used to assess the OS. The multivariable analyses were adjusted for age at diagnosis, sex, race, RT dose, health insurance, histology, education, income, comorbidity score, surgery, chemotherapy, and year of diagnosis. RESULTS: Of the 162,506 patients, 5,548 (3.4%) received PBT. In the multivariable Cox regression analysis, patients who received PBT had longer OS compared to patients who received photon RT (Hazard Ratio (HR): 0.67 [95% CI: 0.64-0.71], p < 0.001). In the subset analyses stratified by surgery, the use of PBT was associated with improved OS compared to photon RT in patients who received surgery (HR:0.76 [95% CI: 0.70-0.82], p < 0.001) and in patients who did not receive surgery (HR: 0.61 [95% CI: 0.57-0.65], p < 0.001). When stratified by histology, PBT was associated with improved OS compared to photon RT in patients diagnosed with astrocytoma (HR: O.65 [95% CI: 0.53-0.81], p < 0.001), glioblastoma (HR: 0.79 [95% CI: 0.71-0.88], p < 0.001) or other types (HR: 0.60 [95% CI: 0.37-0.98], p = 0.04) among patients who received surgery. PBT was also associated with improved OS compared to photon RT in patients diagnosed with astrocytoma (HR: O.44 [95% CI: 0.39-0.50], p < 0.001), glioblastoma (HR: 0.81 [95% CI: 0.73-0.90], p < 0.001) or other types (HR: 0.41 [95% CI: 0.28-0.60], p < 0.001) among those who did not receive surgery. CONCLUSIONS: Patients who received PBT had longer OS compared to patients who received photon RT (HR:0.67 [95% CI: 0.64-0.71], p < 0.001). In the subset analyses stratified by surgery, the use of PBT was associated with improved OS compared to photon RT in patients who received surgery (HR:0.76 [95% CI: 0.70-0.82], p < 0.001) and in patients who did not receive surgery (HR: 0.61 [95% CI: 0.57-0.65], p < 0.001).