scholarly journals 51 Timing of adjuvant treatments on glioblastoma survival: A retrospective cohort analysis based on the national cancer database

2018 ◽  
Vol 45 (S3) ◽  
pp. S11-S12
Author(s):  
Ping Zhu ◽  
Xianglin L. Du ◽  
Yoshua Esquenazi ◽  
Jay-Jiguang Zhu
Keyword(s):  
Adjuvant Treatment ◽  
Survival Benefit ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
High Dose ◽  
National Cancer Database ◽  
Risk Of Death ◽  
Significant Survival Benefit ◽  
Significant Survival ◽  
The Impact

Few studies investigated the associations between intervention modalities, timing, and survival in glioblastoma (GBM) patients. A total of 20511 eligible GBM patients underwent biopsy and craniotomy surgeries followed by adjuvant treatments (2005-2014) were derived from the National Cancer Database (NCDB). The time intervals (days) from the date of diagnosis to the initiation date of adjuvant treatment [radiation therapy only (RT), chemotherapy only, concurrent chemoradiation (CRT), or non-concurrent RT and chemotherapy] were categorized into quartiles (Q1-Q4). Kaplan-Meier method and Cox proportional hazards regression were applied for survival analysis. Multivariate logistic regression was performed to compare differences in treatment timing, intervention modalities, and secondary outcomes. The patients underwent biopsy obtained significant survival benefit by having delayed adjuvant treatment [comparing to Q1, Q2: HR (hazard ratio), 0.88, Q3: HR, 0.86]. For patients underwent resection, the prolonged waiting time of adjuvant treatment had 5-6% reduced risk of death [comparing to Q1, Q2: HR, 0.95; Q3: HR, 0.94]. Patients received more RT fractions [comparing to 10-29 fractions, 30-33 fractions: HR: 0.62 (biopsy), 0.62 (resection); ≥34 fractions: HR: 0.53 (biopsy), 0.62 (resection)] and high-dose RT [comparing to 34-46 Gy, 50-60 Gy: HR: 0.91 (biopsy), 0.95 (resection); ≥ 60 Gy: HR: 0.77 (biopsy), 0.88 (resection)] experienced significantly superior survival in both biopsy and resection groups. The impact of timing to adjuvant treatment on GBM survival varied by surgery procedures. Having adjuvant treatment initiated within 21 days for both biopsy and craniotomy groups may not guarantee a significant survival benefit. More RT fractions and high-dose RT are associated with better GBM survival.

scholarly journals Impact of limb salvage versus amputation on overall survival in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database

2020 ◽  
Author(s):  
Daniel R. Evans ◽  
Alexander Lazarides ◽  
Julia D. Visgauss ◽  
Jason A. Somarelli ◽  
Dan G. Blazer III ◽  
...  
Keyword(s):  
Overall Survival ◽  
Limb Salvage ◽  
Survival Benefit ◽  
Surgical Techniques ◽  
National Cancer Database ◽  
Significant Survival Benefit ◽  
Significant Survival ◽  
Treatment Paradigm ◽  
High Grade Osteosarcoma ◽  
The Impact

Abstract Background: Historically, amputation was the primary surgical treatment for osteosarcoma of the extremities; however, with advancements in surgical techniques and chemotherapies limb salvage has replaced amputation as the dominant treatment paradigm. This study assessed the impact of the type of surgical resection on overall survival in the era of modern limb salvage. Methods: Utilizing the largest registry of primary osteosarcoma, the National Cancer Database (NCDB), we retrospectively analyzed patients with high grade osteosarcoma of the extremities from 2004 through 2015. Unadjusted five-year overall survival between patients who received limb salvage and amputation was assessed utilizing Kaplan Meier curves. A multivariate Cox proportional hazard model and propensity matched analysis was used to determine the variables independently correlated with survival. Results: From a total of 3,421 patients, 2,634 underwent limb salvage and 787 underwent amputation. After controlling for confounders, limb salvage was associated with a significant survival benefit over amputation (HR: 0.70; p<0.001). This survival benefit remained significant after propensity matched analysis of all significantly different independent variables (HR: 0.74; p=0.001). Chemotherapy and negative surgical margins were also independently associated with survival.Conclusion: Limb salvage is associated with a significant survival benefit over amputation, even when controlling for potentially confounding variables and differences between cohorts.

Impact of radiotherapy duration on outcomes in patients with esophageal cancer treated with definitive concurrent radiotherapy and chemotherapy on RTOG trials 8501 and 9405.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 119-119
Author(s):  
Christopher Leigh Hallemeier ◽  
Jennifer Moughan ◽  
Michael G. Haddock ◽  
Arnold M. Herskovic ◽  
Bruce D. Minsky ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Proportional Hazards ◽  
Negative Impact ◽  
Standard Dose ◽  
Cox Proportional Hazards ◽  
High Dose ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Cox Proportional Hazards Models ◽  
The Impact

119 Background: Radiotherapy (RT) interruptions have a negative impact on outcomes in many epithelial malignancies treated with definitive RT. The purpose of this study was to analyze the impact of RT duration on outcomes in patients (pts) with esophageal cancer treated with definitive chemoradiotherapy (CRT). Methods: Pts treated with definitive CRT on RTOG trials 8501 and 9405 were included. Separate analyses were performed in pts receiving standard dose (SD-CRT; 50 Gy + 5FU + cisplatin) and high dose (HD-CRT; 64.8 Gy + 5FU + cisplatin) CRT. Local (LF) and regional (RF) failure were estimated by the cumulative incidence method. Disease-free (DFS) and overall (OS) survival were estimated by the Kaplan-Meier method. Univariate (UVA) and multivariate (MVA) Cox proportional hazards models were utilized to examine for correlation between RT duration (< vs. ≥ median) with LF, RF, DFS and OS. Results: In the SD-CRT cohort (n=235), 96 pts (41%) had ≥ 1 RT interruption for a median of 3 (IQR 1-6) days. The median RT duration was 39 (IQR 37-43) days. In UVA and MVA, RT duration was not associated with LF, RF, DFS, or OS. Estimated outcome rates are in the table. In the HD-CRT cohort (n=107), 64 pts (60%) had ≥ 1 RT interruption for a median of 3.5 (IQR 2-7.5) days. The median RT duration was 52 (IQR 50-57) days. In UVA, RT duration ≥ 52 days was associated with a 33% reduction in risk of DFS failure (HR=0.66, 95% CI [0.44-0.98], p=0.039) and a 29% reduction in risk of death (HR=0.71, 95% CI [0.48-1.06], p=0.09). When excluding the 25 pts with RT dose < 64.8 Gy, RT duration was not associated with DFS or OS. Conclusions: In pts with esophageal cancer receiving definitive SD-CRT, an association between RT duration and outcomes was not observed. In pts receiving HD-CRT, longer RT duration was associated with improved DFS, which may have been due to a significant number of deaths at RT dose < 64.8 Gy. Supported by NCI U10 grants CA21661, CA180868, CA180822, CA37422. Clinical trial information: NCT00002631. [Table: see text]

The impact of neoadjuvant and/or adjuvant treatment modalities in resectable gastric cancer (rGC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16564-e16564
Author(s):  
Camille Ng ◽  
Sungjin Kim ◽  
Michelle Guan ◽  
Andrew Eugene Hendifar ◽  
Haesoo Kim ◽  
...  
Keyword(s):  
Adjuvant Treatment ◽  
Proportional Hazards ◽  
Pathologic Complete Response ◽  
Cox Proportional Hazards ◽  
Surgical Margins ◽  
Treatment Modalities ◽  
Adjuvant Radiation ◽  
Perioperative Therapy ◽  
Risk Of Death ◽  
The Impact

e16564 Background: In rGC ( > cT2), we investigated the impact of various neoadjuvant and/or adjuvant treatment modalities on pathologic complete response (pCR), surgical margins, and overall survival (OS). Methods: The National Cancer Database (NCDB) was interrogated to identify rGC patients (pts) between 2004-2015. Gastric adenocarcinoma cases that were cT2-T4b, any N, M0 and underwent definitive surgery were included. We analyzed the association of 9 treatment groups: neoadjuvant chemoradiation only (nCRT), neoadjuvant chemo only (nCT), adjuvant chemo only (aCT), adjuvant chemoradiation only (aCRT), neoadjuvant chemo and adjuvant radiation (nCTaRT), received any chemo at all (any CT), received any chemoradiation at all (any CRT), received any radiation at all (any RT), and no perioperative therapy (NT) across 3 endpoints: pCR, margin status, and OS using logistic regression and Cox proportional hazards models with adjustment for baseline characteristics. Results: From 183,204 GC cases screened, a total 3061 pts were available with a median follow-up of 41.6 mos and median OS of 29.0 mos. On multivariable analyses, nCRT was associated with the greatest odds of having a pCR (odds ratio or OR 59.6, 95% confidence interval (CI) 10.6-334.1, p < 0.001) with NT as the reference. Having received any RT (OR 0.42, 0.10-1.86), nCRT (OR 0.68, 0.33-1.37), or nCT (OR 0.83, 0.60-1.15) was associated with the lowest odds for having positive surgical margins although none reached p < 0.05. For OS, having received any CT (hazard ratio or HR 0.41, 0.35-0.48) was associated with the lowest risk of death followed by nCRT (HR 0.48, 0.35-0.66), aCT (HR 0.52, 0.43-0.62), aCRT (HR 0.55, 0.48-0.63), any CRT (HR 0.61, 0.41-0.91), nCT (HR 0.62, 0.54-0.71), and nCTaRT (HR 0.67, 0.52-0.87, all p < 0.05). Median OS was greatest in pts treated with any CT (53.9 mos) followed by nCRT (39.1 mos) and aCT (36.1 mos) with 2-year OS rates being 65.6% (95% CI 61.3-69.5%), 63.6% (52.3-73.0%), and 59.7% (54.2-64.7%), respectively. Conclusions: Although nCRT had a high pCR rate, receipt of any CT (neoadjuvant and/or adjuvant) afforded the greatest OS in this modality-by-modality comparison in a large cohort of rGC pts.

Effect of time to initiation of adjuvant chemotherapy on survival in resected pancreatic cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 368-368
Author(s):  
Katelin Anne Mirkin ◽  
Christopher S Hollenbeak ◽  
Joyce Wong
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Chemotherapy ◽  
Surgical Resection ◽  
Survival Benefit ◽  
Term Survival ◽  
Lower Odds ◽  
Significant Survival Benefit ◽  
Significant Survival ◽  
Time To Initiation ◽  
The Impact

368 Background: Pancreatic cancer carries a grim prognosis. Surgical resection followed by adjuvant chemotherapy is standard of care, but little is known about the temporal relationship of chemotherapy initiation and survival. This study analyzed the impact of time to initiation of adjuvant chemotherapy on survival in patients with resected pancreatic cancer. Methods: The National Cancer Data Base (2003-2011) was retrospectively reviewed for patients with clinical stages 1-3 resected pancreatic carcinoma. Time to chemotherapy was stratified at the 12-week post-operative timepoint. Univariate statistics, Kaplan-Meier estimates, and Cox proportional hazard modeling were performed. Results: 5,205 patients who had undergone surgical resection alone, 3,144 patients who had undergone surgical resection and adjuvant chemotherapy initiated at or before 12 weeks, and 906 patients who had undergone surgical resection followed by adjuvant therapy started after 12 weeks were included. Patients who received chemotherapy > 12 weeks tended to be older, have more co-morbidities, receive treatment at academic centers, and undergo whipple procedures. In all pathologic disease stages, adjuvant chemotherapy conferred a significant survival benefit over surgical resection alone (p < 0.0001). However, there was no significant overall survival benefit for patients receiving adjuvant chemotherapy before 12 weeks as compared to after (p = 0.85). When stratified by pathological stage, there was still no significant survival benefit for earlier initiation of chemotherapy (£ vs. > 12 weeks): stage I, p = 0.16, stage II, p = 0.12, stage III, p = 0.38. After controlling for patient, disease, and surgery characteristics, patients who received adjuvant chemotherapy after 12 weeks had a 31% lower odds of mortality at 5 years, while those who initiated it before 12 weeks had a 34% lower odds (p < 0.0001, p < 0.0001 respectively), versus surgery-alone. Conclusions: Earlier initiation of adjuvant chemotherapy does not significantly impact long-term survival in patients with resected pancreatic cancer. However, because adjuvant chemotherapy confers a survival benefit, delayed chemotherapy should be offered when appropriate.

Esthesioneuroblastoma: A Patterns-of-Care and Outcomes Analysis of the National Cancer Database

Neurosurgery ◽  
2018 ◽  
Vol 83 (5) ◽  
pp. 940-947 ◽  
Author(s):  
Andrew Orton ◽  
Dustin Boothe ◽  
Daniel Evans ◽  
Shane Lloyd ◽  
Marcus M Monroe ◽  
...  
Keyword(s):  
Treatment Modality ◽  
Survival Benefit ◽  
Proportional Hazards ◽  
Postoperative Radiotherapy ◽  
Cohort Analysis ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Risk Of Death ◽  
Primary Surgery ◽  
Primary Treatment Modality

Abstract BACKGROUND The available literature to guide treatment decision making in esthesioneuroblastoma (ENB) is limited. OBJECTIVE To define treatment patterns and outcomes in ENB according to treatment modality using a large national cancer registry. METHODS This study is a retrospective cohort analysis of 931 patients with a diagnosis of ENB who were treated with surgery, radiation therapy, and/or chemotherapy in the United States between the years of 2004 and 2012. Log-rank statistics were used to compare overall survival by primary treatment modality. Logistic regression modeling was used to identify predictors of receipt of postoperative radiotherapy (PORT). Cox proportional hazards modeling was used to determine the survival benefit of PORT. Subgroup analyses identified subgroups that derived the greatest benefit of PORT. RESULTS Primary surgery was the most common treatment modality (90%) and resulted in superior survival compared to radiation (P &lt; .01) or chemotherapy (P &lt; .01). On multivariate analysis, PORT was associated with decreased risk of death (hazard ratio [HR] 0.53, P &lt; .01). PORT showed a survival benefit in Kadish stage C (HR 0.42, P &lt; .01) and D (HR 0.09, P = .01), but not Kadish A (HR 1.17, P = .74) and B (HR 1.37, P = .80). Patients who received chemotherapy derived greater benefit from PORT (HR 0.22, P &lt; .01) compared with those who did not (HR 0.68, P = .13). Predictors of PORT included stage, grade, extent of resection, and chemotherapy use. CONCLUSION Best outcomes were obtained in patients undergoing primary surgery. The benefit of PORT was driven by patients with stages C and D disease, and by those also receiving chemotherapy.

scholarly journals Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Daniel R. Evans ◽  
Alexander L. Lazarides ◽  
Julia D. Visgauss ◽  
Jason A. Somarelli ◽  
Dan G. Blazer ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Survival Benefit ◽  
Surgical Techniques ◽  
National Cancer Database ◽  
Lower Income ◽  
Significant Survival Benefit ◽  
Significant Survival ◽  
Choice Of Treatment ◽  
Treatment Paradigm ◽  
High Grade Osteosarcoma

Abstract Background Historically, amputation was the primary surgical treatment for osteosarcoma of the extremities; however, with advancements in surgical techniques and chemotherapies limb salvage has replaced amputation as the dominant treatment paradigm. This study assessed the type of surgical resection chosen for osteosarcoma patients in the twenty-first century. Methods Utilizing the largest registry of primary osteosarcoma, the National Cancer Database (NCDB), we retrospectively analyzed patients with high grade osteosarcoma of the extremities from 2004 through 2015. Differences between patients undergoing amputation and patients undergoing limb salvage are described. Unadjusted five-year overall survival between patients who received limb salvage and amputation was assessed utilizing Kaplan Meier curves. A multivariate Cox proportional hazard model and propensity matched analysis was used to determine the variables independently correlated with survival. Results From a total of 2442 patients, 1855 underwent limb salvage and 587 underwent amputation. Patients undergoing amputation were more likely to be older, male, uninsured, and live in zip codes associated with lower income. Patients undergoing amputation were also more likely to have larger tumors, more comorbid conditions, and metastatic disease at presentation. After controlling for confounders, limb salvage was associated with a significant survival benefit over amputation (HR: 0.70; p < 0.001). Although this may well reflect underlying biases impacting choice of treatment, this survival benefit remained significant after propensity matched analysis of all significantly different independent variables (HR: 0.71; p < 0.01). Conclusion Among patients in the NCDB, amputation for osteosarcoma is associated with advanced age, advanced stage, larger tumors, greater comorbidities, and lower income. Limb salvage is associated with a significant survival benefit, even when controlling for significant confounding variables and differences between cohorts.

scholarly journals Impact of an Intermediate Respiratory Care Unit on Clinical Outcomes of COVID-19 Patients

2020 ◽  
Author(s):  
Guillermo Suarez-Cuartin ◽  
Merce Gasa ◽  
Guadalupe Bermudo ◽  
Yolanda Ruiz-Albert ◽  
Marta Hernandez-Argudo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Respiratory Support ◽  
Respiratory Care ◽  
High Dose ◽  
Risk Of Death ◽  
Systemic Corticosteroids ◽  
The Impact

Abstract Background: Many severe COVID-19 patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the impact of an IMCU in the management of severe COVID-19.Methods: Observational, retrospective study including patients admitted to the IMCU due to COVID-19 pneumonia during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality.Results: A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6% Vs 24.2%; p<0.001). Multivariable proportional hazards model showed that age ³65 years (HR 4.14; 95%CI 2.31-7.42; p<0.001); chronic respiratory conditions (HR 2.34; 95%CI 1.38-3.99; p=0.002) and chronic kidney disease (HR 2.96; 95%CI 1.61-5.43; p<0.001) were independently associated with mortality. High-dose systemic corticosteroids followed by progressive dose tapering showed a lower risk of death (HR 0.15; 95%CI 0.06-0.40; p<0.001). Conclusions: IMCU allow to safely and effectively manage severe COVID-19 patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality.

scholarly journals Extent of resection in glioblastoma: a 10-year local survival analysis

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv19-iv19
Author(s):  
Theodore Hirst ◽  
Patrick McAleavey ◽  
Tom Flannery
Keyword(s):  
Neurological Deficit ◽  
Survival Benefit ◽  
Extent Of Resection ◽  
Cox Proportional Hazards ◽  
Partial Resection ◽  
Gross Total Resection ◽  
Molecular Profile ◽  
Total Resection ◽  
Local Survival ◽  
The Impact

Abstract Aims The impact on extent of resection (EOR) in glioblastoma has been well documented. It is clear that gross-total resection (GTR) confers best overall survival (OS), however the minimum EOR required to confer a survival benefit over biopsy is debated. Recent studies favour partial resection (PR) over biopsy for IDH-wildtype, MGMT-unmethylated tumours. We describe our experiences locally with these principles in mind. Method Retrospective evaluation of a single surgeon cohort. All patients over 18 years old, undergoing a surgical treatment for histologically confirmed GBM in the stated period were included. We collected information on demographics, tumour volume, EOR, complications, adjuvant therapies, molecular profile, and OS. We used log rank tests and Cox Proportional Hazards Models to identify factors associated with OS. Results The patient and tumour characteristics of our cohort were similar to those documented in the literature. The mean age was 56.6 years. 72 patients underwent biopsy and 202 had debulking surgery. Median OS was 11 months. Of those debulked, gross-total resection was achieved in 41 patients (20%); associated median OS was 29 months. Patients receiving partial resection (defined as EOR &lt;80%) had no clear survival benefit over patients undergoing biopsy (median OS 6 vs 5 months) but had a higher rate of post-op neurological deficit (3% vs 12%). Tumour molecular profile appeared to influence survival outcome in a manner comparable to worldwide experience. Conclusion In our experience, partial resection is not a justifiable surgical aim in the typical glioblastoma cohort. The limited benefit that it may confer over biopsy appears to be outweighed by the risk of neurological deficit that affects quality and probably quantity of life. This finding applies to our glioblastoma population in general as well as those specifically with an MGM-unmethylated tumour.

Defining the Impact of Adjuvant Treatment on the Prognosis of Patients with Inoperable Glioblastoma Undergoing Biopsy-only: Does the Survival Benefit Outweigh the Treatment Effort?

2021 ◽  
Author(s):  
Ronja Löber-Handwerker ◽  
Katja Döring ◽  
Christoph Bock ◽  
Veit Rohde ◽  
Vesna Malinova
Keyword(s):  
Adjuvant Treatment ◽  
Survival Benefit ◽  
Rank Test ◽  
Tumor Biopsy ◽  
Entire Cohort ◽  
Good Clinical Condition ◽  
The Impact ◽  
Radio Chemotherapy ◽  
Worse Prognosis

Abstract Purpose: Patients with inoperable glioblastoma (GBM) usually experience worse prognosis compared to those in whom gross total resection (GTR) is achievable. Considering the treatment duration and its side effects identification of patients with survival benefit from treatment is essential to guarantee the best achievable quality of life. The aim of this study was to evaluate the survival benefit from radio-chemotherapy and to identify clinical, molecular, and imaging parameters associated with better outcome in patients with biopsied GBMs. Methods: Consecutive patients with inoperable GBM, who underwent tumor biopsy at our department from 2005 to 2019 were retrospectively analyzed. All patients had histologically confirmed GBM and were followed up until death. The overall survival (OS) was calculated from date of diagnosis to date of death. Clinical, radiological and molecular predictors of OS were evaluated. Results: A total of 95 patients with biopsied primary GBM were enrolled in the study. The mean age was 64.3±13.2 years, 56.8 % (54/95) were male and 43.2 % (41/95) female. Mean OS in the entire cohort was 9 months. After stratification for adjuvant treatment a higher median OS was found in the group with adjuvant treatment (7 months, range 2-88) compared to the group without treatment (1 month, range 1-5) Log-rank test, p<0.0001.Conclusion: Patients with inoperable GBM undergoing biopsy indeed experience a very limited OS. Adjuvant treatment is associated with significantly longer OS compared to patients not receiving treatment and should be considered, especially in younger patients with good clinical condition at presentation.

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