Abstract
Purpose
Methods and Materials
Results
Conclusions
Introduction
The National Association for Proton Therapy. Proton therapy centers in the U.S. Available at: https://www.proton-therapy.org/map/. Accessed March 21, 2020.
Methods and Materials
Results
Characteristic | Photons, n (%) | Protons, n (%) | P value | ||
---|---|---|---|---|---|
Age, y | <.01 | ||||
0-5 | 2279 | 28 | 373 | 29 | |
6-10 | 2519 | 31 | 339 | 31 | |
11-18 | 3283 | 41 | 333 | 32 | |
Year of diagnosis | <.01 | ||||
2004-2008 | 3022 | 37 | 84 | 8 | |
2009-2012 | 2411 | 30 | 231 | 22 | |
2013-2017 | 2648 | 33 | 730 | 70 | |
Race | <.01 | ||||
White | 6189 | 77 | 794 | 76 | |
Black | 1079 | 13 | 68 | 7 | |
Asian | 329 | 4 | 50 | 5 | |
Native American/Eskimo | 55 | 1 | 10 | 1 | |
Native HI/Pacific Islander | 20 | <1 | 4 | <1 | |
Other/unknown | 409 | 5 | 119 | 11 | |
Ethnicity | .81 | ||||
Non-Hispanic/unreported | 6820 | 85 | 878 | 86 | |
Hispanic white | 1136 | 14 | 141 | 14 | |
Hispanic black | 32 | <1 | 3 | <1 | |
Insurance status | <.01 | ||||
Privately insured | 4734 | 63 | 702 | 72 | |
Medicaid | 2768 | 37 | 276 | 28 | |
Charlson comorbidity index | .18 | ||||
0 | 7407 | 92 | 977 | 93 | |
1 | 359 | 4 | 39 | 4 | |
2 | 245 | 3 | 22 | 2 | |
3 + | 70 | 1 | 7 | 1 | |
Income ($) | <.01 | ||||
<30,000 | 1049 | 15 | 76 | 8 | |
30,000-34,999 | 1256 | 17 | 116 | 12 | |
35,000-45,999 | 2025 | 28 | 284 | 31 | |
46,000 + | 2892 | 40 | 450 | 49 | |
Distance from treatment, miles | 0.02 | ||||
<50 | 5349 | 72 | 643 | 67 | |
51-200 | 1733 | 23 | 255 | 27 | |
>200 | 391 | 5 | 59 | 6 | |
Community type | <.01 | ||||
Metro | 6413 | 83 | 892 | 90 | |
Urban | 853 | 11 | 72 | 7 | |
Rural | 485 | 6 | 27 | 3 | |
Histology | <.01 | ||||
Low-grade glioma | 1862 | 24 | 114 | 11 | |
High-grade glioma | 1803 | 23 | 99 | 10 | |
Ependymoma | 1034 | 13 | 239 | 23 | |
Medulloblastoma | 1967 | 25 | 379 | 37 | |
PNET | 286 | 4 | 40 | 4 | |
Craniopharyngioma | 59 | 1 | 9 | 1 | |
Germ cell tumors | 350 | 4 | 59 | 6 | |
Meningioma | 119 | 2 | 11 | 1 | |
ATRT | 203 | 3 | 51 | 5 | |
Other | 153 | 2 | 28 | 3 |
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
Predictor | Odds ratio | 95% CI | P value | Odds ratio | 95% CI | P value |
Age, y | ||||||
0-5 | 1.6 | 1.4-1.9 | <.01 | 1.3 | 1.1-1.6 | .01 |
6-10 | 1.3 | 1.1-1.6 | <.01 | 1.1 | 0.9-1.4 | .31 |
11-18 | - | - | - | - | - | - |
Year of diagnosis | ||||||
2004-2008 | - | - | - | - | - | - |
2009-2012 | 3.5 | 2.7-4.5 | <.01 | 4.2 | 3.2-5.7 | <.01 |
2013-2017 | 10 | 7.9-13 | <.01 | 11 | 8.5-15 | <.01 |
Race | ||||||
White | - | - | - | - | - | - |
Black | 0.48 | 0.38-0.63 | <.01 | 0.62 | 0.45-0.85 | <.01 |
Asian | 1.2 | 0.87-1.6 | .28 | 1.1 | 0.77-1.6 | .56 |
Native American/Eskimo | 1.4 | 0.72-2.8 | .31 | 1.4 | 0.54-3.4 | .52 |
Native HI/Pacific Islander | 1.6 | 0.53-4.6 | .42 | 1.8 | 0.55-6.1 | .33 |
Other/unknown | 2.3 | 1.8-2.8 | <.01 | 2.3 | 1.7-3.1 | <.01 |
Ethnicity | ||||||
Non-Hispanic/unreported | - | - | - | - | - | - |
Hispanic white | 0.96 | 0.80-1.2 | .70 | 1.0 | 0.80-1.3 | .83 |
Hispanic black | 0.73 | 0.22-2.4 | .60 | 0.63 | 0.08-5.0 | .66 |
Insurance status | ||||||
Privately insured | - | - | - | - | - | - |
Medicaid | 0.67 | 0.58-0.78 | <.01 | 0.62 | 0.51-0.75 | <.01 |
Charlson comorbidity index | ||||||
0 | - | - | - | - | - | - |
1 | 0.82 | 0.59-1.2 | .26 | 0.70 | 0.45-1.1 | .10 |
2 | 0.68 | 0.44-1.1 | .09 | 0.90 | 0.52-1.5 | .68 |
3 + | 0.76 | 0.35-1.7 | .49 | 1.0 | 0.38-2.6 | .98 |
Income ($) | ||||||
<30,000 | - | - | - | - | - | - |
30,000-34,999 | 1.3 | 0.94-1.7 | .11 | 1.1 | 0.75-1.5 | .74 |
35,000-45,999 | 1.9 | 1.5-2.5 | <.01 | 1.5 | 1.1-2.0 | .02 |
46,000 + | 2.2 | 1.7-2.8 | <.01 | 1.6 | 1.2-2.3 | .01 |
Distance from treatment, miles | ||||||
<50 | - | - | - | - | - | - |
51-200 | 1.2 | 1.1-1.4 | <.01 | 1.4 | 1.2-1.8 | <.01 |
>200 | 1.3 | 0.94-1.7 | .12 | 1.6 | 1.1-2.5 | .02 |
Community type | ||||||
Metro | - | - | - | - | - | - |
Urban | 0.61 | 0.47-0.78 | <.01 | 0.72 | 0.53-0.99 | .05 |
Rural | 0.4 | 0.27-0.59 | <.01 | 0.47 | 0.29-0.75 | <.01 |
Histology | ||||||
Low-grade glioma | - | - | - | - | - | - |
High-grade glioma | 0.9 | 0.68-1.2 | .44 | 0.82 | 0.59-1.2 | .25 |
Ependymoma | 3.8 | 3.0-4.8 | <.01 | 3.9 | 2.9-5.2 | <.01 |
Medulloblastoma | 3.2 | 2.5-3.9 | <.01 | 3.6 | 2.8-4.7 | <.01 |
PNET | 2.3 | 1.6-3.3 | <.01 | 3.3 | 2.1-5.2 | <.01 |
Craniopharyngioma | 2.5 | 1.2-5.2 | .01 | 1.9 | 0.72-5.3 | .19 |
Germ cell tumors | 2.8 | 2.0-3.9 | <.01 | 3.4 | 2.2-5.0 | <.01 |
Meningioma | 1.5 | 0.79-2.9 | .21 | 2.0 | 0.95-4.0 | .07 |
ATRT | 4.1 | 2.9-5.9 | <.01 | 3.7 | 2.3-5.7 | <.01 |
Other | 3.0 | 1.9-4.7 | <.01 | 3.6 | 2.1-6.2 | <.01 |
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
Predictor | Odds ratio | 95% CI | P value | Odds ratio | 95% CI | P value |
Age, y | ||||||
0-5 | 1.3 | 1.1-1.6 | <.01 | 1.3 | 1.1-1.7 | <.01 |
6-10 | 1.2 | 1.01-1.4 | .04 | 1.2 | 0.9-1.5 | .21 |
11-18 | - | - | - | - | - | - |
Year of diagnosis | ||||||
2004-2008 | - | - | - | - | - | - |
2009-2012 | 4.3 | 3.2-5.8 | <.01 | 5.0 | 3.6-6.8 | <.01 |
2013-2017 | 13 | 10-17 | <.01 | 13 | 9.7-17.8 | <.01 |
Race | ||||||
White | - | - | - | - | - | - |
Black | 0.48 | 0.36-.63 | <.01 | 0.63 | 0.45-0.90 | .01 |
Asian | 1.3 | 0.95-1.8 | .10 | 1.2 | 0.84-1.8 | .29 |
Native American/Eskimo | 1.6 | 0.80-3.2 | .19 | 1.5 | 0.58-3.9 | .41 |
Native HI/Pacific Islander | 1.6 | 0.46-5.8 | .45 | 1.6 | 0.40-6.6 | .50 |
Other/unknown | 2.2 | 1.7-2.8 | <.01 | 2.1 | 1.9-4.0 | <.01 |
Ethnicity | ||||||
Non-Hispanic/unreported | - | - | - | - | - | - |
Hispanic white | 0.87 | 0.71-1.1 | .20 | 0.94 | 0.71-1.2 | .66 |
Hispanic black | 0.56 | 0.13-2.4 | .43 | 0.70 | 0.08-5.8 | .74 |
Insurance status | ||||||
Privately insured | - | - | - | - | - | - |
Medicaid | 0.66 | 0.56-0.78 | <.01 | 0.62 | 0.50-0.76 | <.01 |
Charlson comorbidity index | ||||||
0 | - | - | - | - | - | - |
1 | 0.84 | 0.58-1.2 | .34 | 0.72 | 0.45-1.2 | .18 |
2 | 0.85 | 0.51-1.4 | .53 | 0.90 | 0.46-1.7 | .74 |
3 + | 1.2 | 0.49-2.8 | .73 | 1.5 | 0.54-4.3 | .42 |
Income ($) | ||||||
<30,000 | - | - | - | - | - | - |
30,000-34,999 | 1.3 | 0.94-1.9 | .10 | 1.2 | 0.80-1.8 | .40 |
35,000-45,999 | 2.1 | 1.6-2.8 | <.01 | 1.7 | 1.2-2.4 | .01 |
46,000 + | 2.4 | 1.8-3.2 | <.01 | 1.9 | 1.3-2.7 | <.01 |
Distance from treatment, miles | ||||||
<50 | - | - | - | - | - | - |
51-200 | 1.26 | 1.06-1.49 | .01 | 1.6 | 1.3-2.0 | <.01 |
>200 | 1.35 | 0.98-1.87 | .07 | 1.7 | 1.1-2.7 | .02 |
Community type | ||||||
Metro | - | - | - | - | - | - |
Urban | 0.65 | 0.50-0.85 | <.01 | 0.76 | 0.54-1.1 | .11 |
Rural | 0.40 | 0.26-0.61 | <.01 | 0.46 | 0.27-0.78 | <.01 |
Histology | ||||||
Low-grade glioma | - | - | - | - | - | - |
Ependymoma | 3.8 | 3.0-4.8 | <.01 | 3.9 | 2.9-5.2 | <.01 |
Medulloblastoma | 3.2 | 2.5-3.9 | <.01 | 3.6 | 2.8-4.7 | <.01 |
PNET | 2.3 | 1.6-3.3 | <.01 | 3.3 | 2.1-5.3 | <.01 |
Craniopharyngioma | 2.5 | 1.2-5.2 | .01 | 1.9 | 0.70-5.2 | .21 |
Germ cell tumors | 2.8 | 2.0-3.9 | <.01 | 3.4 | 2.2-5.1 | <.01 |
ATRT | 4.1 | 2.9-5.9 | <.01 | 3.7 | 2.4-5.8 | <.01 |

Discussion
The National Association for Proton Therapy. Proton therapy centers in the U.S. Available at: https://www.proton-therapy.org/map/. Accessed March 21, 2020.
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Sources of support: This work had no specific funding.
Disclosures: All authors have no financial disclosures and no conflicts of interest.
Data sharing statement: All data from the National Cancer Database are available through the American College of Surgeons. Research STATA code available on request.
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