Definitive Radiotherapy versus Surgery for the Treatment of Verrucous Carcinoma of the Larynx: A National Cancer Database Study

Abstract Introduction Traditionally, larger lesions of laryngeal verrucous carcinoma are treated with surgical excision, with definitive radiotherapy generally reserved for smaller lesions. However, data utilizing modern databases is limited. Objective The authors sought to assess, utilizing the National Cancer Database, whether overall survival for patients with laryngeal verrucous carcinoma was equivalent when treated with definitive radiotherapy versus definitive surgery. Methods A retrospective cohort study was conducted utilizing the National Cancer Database. All cases of laryngeal verrucous carcinoma within the National Cancer Database between 2006 and 2014 were reviewed. Patients with T1–T3 (American Joint Commission on Cancer 7th Edition) laryngeal verrucous carcinoma were included and stratified by treatment modality. Demographics, treatment, and survival data were analyzed. Results A total of 392 patients were included. Two hundred and fifty patients underwent surgery and 142 received radiotherapy. The two groups differed in age, transition of care, clinical T stage, and clinical stages. There was no significant difference in survival between T1–T3 lesions treated with surgery or radiotherapy (p = 0.32). Age, comorbidities, insurance status, and clinical T stage impacted overall hazard on multivariate analysis (p < 0.01). For patients treated with radiotherapy, age, insurance status, and clinical T stage were predictive of increased hazard. Conclusion Overall survival is equivalent for patients with clinical T1 and clinical T2 laryngeal verrucous carcinoma treated with primary radiotherapy versus primary surgery. Thus, radiotherapy should be considered as a non-inferior treatment modality for certain patients with laryngeal verrucous carcinoma.

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Outcomes of Active Surveillance Versus Initial Treatment for Nodular Lymphocyte Predominant Hodgkin Lymphoma: A National Cancer Database (NCDB) Analysis of 2,480 Patients

Blood ◽

10.1182/blood-2020-142828 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 29-30

Author(s):

Matthew J Cortese ◽

Wei Wei ◽

Brian T. Hill

Keyword(s):

Overall Survival ◽

B Cell ◽

Hodgkin Lymphoma ◽

Treatment Modality ◽

Initial Treatment ◽

Research Funding ◽

Univariate Analysis ◽

National Cancer Database ◽

Initial Management ◽

Significant Difference

Introduction Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) is a unique and clinically distinct subtype of Hodgkin lymphoma (HL), comprising approximately 5% of all HL cases with an annual incidence of about 1-2 cases per million. Compared with classical HL (cHL), NLPHL is more likely to present with limited stage and a more indolent clinical course. Despite these favorable traits, systemic chemoimmunotherapies and/or radiation are often used for initial treatment. Deaths directly from NLPHL are uncommon, with mortality in these patients often attributable to treatment-related toxicities or transformation to aggressive non-Hodgkin B-cell lymphomas. There is emerging evidence that NLPHL can be treated more conservatively. Active Surveillance (AS), a strategy by which initial treatment is deferred in favor of close observation, has been evaluated in single-institution retrospective studies spanning decades. Borchmannet alreported comparable overall survival (OS) for patients managed with AS versus upfront treatment (Blood, 2019). While encouraging, additional contemporary data are needed to determine if AS is a safe option for NLPHL patients, given advances in supportive care, addition of anti-CD20 therapies, improved radiation delivery, and better diagnostic methods. This retrospective National Cancer Database (NCDB) study evaluates the effect of initial treatment modality on overall survival in a contemporary population of patients with NLPHL to determine if initial AS has comparable OS when compared with initial treatment. Methods The National Cancer Database (NCDB) is a nationwide oncology outcomes database for more than 1500 accredited cancer programs in the United States. The NCDB was queried for all patients with the diagnosis of NLPHL, defined by histology code 9659. Filters for inclusion included year of diagnosis from 2010 to 2015, B-cell/pre-B/B-precursor histologic subtype, known treatment status, and with survival data available. Demographic, socioeconomic, treatment modality, and clinical factors such as stage and Charlson-Deyo comorbidity indices were summarized. Chi-square tests were used to correlate factors with treatment status. Kaplan-Meier methods were used to estimate overall survival, and log rank test was used to compare OS between patient groups. Cox proportional hazard model was used to associate patient characteristics with OS, and backwards elimination was used to identify the final Cox model, starting from all factors in univariate analysis. Results A total of 2,480 patients with NLPHL diagnosed between 2010 and 2015 were included. Of these, 553 patients were older than 60 years (22.3%), 1,616 were male (65%), and 2,110 had a Charlson-Deyo score of 0 (85%) while 370 had a score of ≥1 (15%). 1,627 had Stage I-II disease (65.6%) while 731 had Stage III-IV disease (29.5%). Overall, 2,330 patients were alive (94%) and 150 were deceased (6%), with a median follow-up of 36.8 months (range 0.1 to 94.3 months). Initial management options included: treatment (radiation, chemo/immunotherapy, and/or surgery), no treatment (e.g. palliative care only), or AS. 2,309 patients (93.1%) were initially treated (IT), 103 (4.15%) received no treatment (NT) and 68 patients (2.74%) underwent AS. OS by treatment strategy is shown in Figure 1. In univariate analysis, there was no OS difference between IT vs AS (HR 0.71; 95% CI 0.31-1.61, P=0.41) or NT vs. AS (HR 2.03; 95% CI 0.75-5.51; P= 0.16), but there was a significant difference between NT and IT (HR 2.87; 95% CI 1.56-5.32, P=0.0008). In the final Cox multivariate analysis, there was no significant difference between three treatment groups (overall P=0.10). Age >60, male gender, those with government insurance, Charlson-Deyo score ≥1, and Stage IV were all associated with decreased OS (Table 1). Conclusion In this large NCDB outcomes analysis of 2,480 NLPHL patients, those selected for AS had no difference in overall survival compared to patients who were initially treated. This lends support to emerging evidence that AS is a viable option for a subset newly diagnosed NLPHL patients, as is routine for indolent non-Hodgkin Lymphoma. Future study is needed to identify clinical features associated with a more indolent NLPHL phenotype that may be amendable to less intense initial management. Disclosures Hill: Karyopharm:Consultancy, Honoraria, Research Funding;Takeda:Research Funding;Celgene:Consultancy, Honoraria, Research Funding;BMS:Consultancy, Honoraria, Research Funding;Novartis:Consultancy, Honoraria;Kite, a Gilead Company:Consultancy, Honoraria, Research Funding;AstraZenica:Consultancy, Honoraria, Research Funding;Beigene:Consultancy, Honoraria, Research Funding;Pharmacyclics:Consultancy, Honoraria, Research Funding;Abbvie:Consultancy, Honoraria, Research Funding;Genentech:Consultancy, Honoraria, Research Funding.

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Updated predictive analysis of the WHO-defined molecular subgroups of low-grade gliomas within the high-risk treatment arms of NRG Oncology/RTOG 9802.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.2002 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 2002-2002 ◽

Cited By ~ 2

Author(s):

Erica Hlavin Bell ◽

Minhee Won ◽

Jessica L. Fleming ◽

Aline P. Becker ◽

Joseph P. McElroy ◽

...

Keyword(s):

Overall Survival ◽

High Risk ◽

Survival Data ◽

Progression Free Survival ◽

Phase Iii ◽

Rank Test ◽

Low Grade ◽

Low Grade Gliomas ◽

Significant Difference ◽

Post Hoc

2002 Background: This study sought to update the predictive significance of the three WHO-defined molecular glioma subgroups ( IDHwt, IDHmt/noncodel, and IDHmt/codel) in the subset of specimens available for analysis in NRG Oncology/RTOG 9802, a phase III trial of high-risk low-grade gliomas (LGGs) treated with radiation (RT) with and without PCV after biopsy/surgical resection. Notably, this is the first phase III study to evaluate the predictive value of the WHO subgroups in LGGs using prospectively-collected, well-annotated long-term overall survival data, in a post-hoc analysis. Methods: IDH1/2 mutation status was determined by immunohistochemistry and/or next-generation sequencing. 1p/19q status was determined by Oncoscan and/or 450K methylation data. Treatment effects on overall survival (OS) and progression-free survival (PFS) by marker status were determined by the Cox proportional hazard model and tested using the log-rank test in a secondary and exploratory analysis. Results: Of all the randomized eligible high-risk G2 patients (N = 251) in NRG Oncology/RTOG 9802, 106(42%) patients had tissue available with sufficient quality DNA for profiling. Of these, 80(75%) were IDHmut; 43(41%) were IDHmut/non-co-deleted, 37(35%) were IDHmut/co-deleted, and 26(24%) were IDHwt. Upon univariate analyses, no significant difference in either PFS or OS was observed with the addition of PCV in the IDHwt subgroup. Both the IDHmut/non-co-deleted and IDHmut/co-deleted subgroups were significantly correlated with longer PFS (HR = 0.32; p = 0.003; HR = 0.13; p < 0.001) and OS (HR = 0.38; p = 0.013; HR = 0.21; p = 0.029) in the RT plus PCV arm, respectively. Conclusions: Our analyses suggest that both IDHmut/non-co-deleted and IDHmut/co-deleted subgroups received benefit from treatment with PCV although sample size is limited and analyses are post-hoc. Our results also support the notion that IDHwt high-risk LGG patients do not benefit from the addition of PCV to RT. Funding: U10CA180868, U10CA180822, and U24CA196067. Also, R01CA108633, R01CA169368, RC2CA148190, U10CA180850-01, BTFC, OSU-CCC (all to AC). Clinical trial information: NCT00003375.

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Survival outcomes between surgery with adjuvant therapy compared to neoadjuvant therapy with surgery in stage I pancreatic adenocarcinoma: Results from a large national cancer database.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.335 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 335-335 ◽

Cited By ~ 2

Author(s):

Samit Kumar Datta ◽

Geoffrey Belini ◽

Maharaj Singh ◽

Wesley Allan Papenfuss ◽

Federico Augusto Sanchez ◽

...

Keyword(s):

Overall Survival ◽

Adjuvant Therapy ◽

Neoadjuvant Therapy ◽

Pancreatic Adenocarcinoma ◽

Reference Group ◽

Clinical Stage ◽

National Cancer Database ◽

Nccn Guidelines ◽

Significant Difference ◽

Stage 1

335 Background: There has been a paradigm shift in the treatment of stage 1 pancreatic adenocarcinoma (PAC) from surgery first followed by adjuvant therapy (AT) to Neoadjuvant therapy (NAT) first followed by surgery and this is reflected in the current NCCN guidelines as well. Data comparing these two modalities are limited. AIM: To compare long time survival between surgery vs Surgery + AT and NAT + Surgery in a large National Cancer Database. Methods: We identified patients with surgically resected AJCC clinical stage 1, 1A, and 1B PAC between 2004-2014. Patients were stratified into 3 groups to assess outcomes. Exclusion criteria: those with incomplete survival and sequence of therapy data. Hazard ratios (HR) were calculated for evaluation of survival, as well as for 30-Day and 90-Day Mortality between the 3 groups. Results were adjusted for age and Deyo-Charlson comorbidity index. Results: A total of 9684 pts with Clincal stage 1, 1A, 1B PAC between 2004-2014 were identified. Of these 2266 pts underwent surgery alone; 6222 had surgery followed by AT; and 1196 pts had neoadjuvant therapy followed by surgery. There was a HR of 0.995 (95% CI 0.935-1.058 p = 0.864) and 0.984 (95% CI 0.924-1.048, p = 0.617) for 30- and 90-Day mortality comparing upfront surgery to NAT, respectively. With AT as the reference group for survival, there was a HR of 1.362 (95% CI 1.286-1.443, p < 0.001) for surgery only and HR of 0.929 (95% CI 0.859-1.004, p = 0.064) for NAT. Conclusions: 1. Surgery alone had worse overall survival. 2. There was no significant difference in overall survival when comparing AT and NAT 3. A prospective randomized trial evaluating the differences in survival is needed.

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The role for adjuvant radiotherapy in the treatment of hemangiopericytoma: a Surveillance, Epidemiology, and End Results analysis

Journal of Neurosurgery ◽

10.3171/2013.10.jns13113 ◽

2014 ◽

Vol 120 (2) ◽

pp. 300-308 ◽

Cited By ~ 33

Author(s):

Adam M. Sonabend ◽

Brad E. Zacharia ◽

Hannah Goldstein ◽

Samuel S. Bruce ◽

Dawn Hershman ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Radiation Therapy ◽

Survival Data ◽

Survival Benefit ◽

Radiation Treatment ◽

Univariate Analysis ◽

Adjuvant Radiation ◽

Significant Difference ◽

End Results

Object Central nervous system (CNS) hemangiopericytomas are relatively uncommon and unique among CNS tumors as they can originate from or develop metastases outside of the CNS. Significant difference of opinion exists in the management of these lesions, as current treatment paradigms are based on limited clinical experience and single-institution series. Given these limitations and the absence of prospective clinical trials within the literature, nationwide registries have the potential to provide unique insight into the efficacy of various therapies. Methods The authors queried the Surveillance Epidemiology and End Results (SEER) database to investigate the clinical behavior and prognostic factors for hemangiopericytomas originating within the CNS during the years 2000–2009. The SEER survival data were adjusted for demographic factors including age, sex, and race. Univariate and multivariate analyses were performed to identify characteristics associated with overall survival. Results The authors identified 227 patients with a diagnosis of CNS hemangiopericytoma. The median length of follow-up was 34 months (interquartile range 11–63 months). Median survival was not reached, but the 5-year survival rate was 83%. Univariate analysis showed that age and radiation therapy were significantly associated with survival. Moreover, young age and supratentorial location were significantly associated with survival on multivariate analysis. Most importantly, multivariate analysis using the Cox proportional hazards model showed a statistically significant survival benefit for patients treated with gross-total resection (GTR) in combination with adjuvant radiation treatment (HR 0.31 [95% CI 0.01–0.95], p = 0.04), an effect not appreciated with GTR alone. Conclusions The authors describe the epidemiology of CNS hemangiopericytomas in a large, national cancer database, evaluating the effectiveness of various treatment paradigms used in clinical practice. In this study, an overall survival benefit was found when GTR was accomplished and combined with radiation therapy. This finding has not been appreciated in previous series of patients with CNS hemangiopericytoma and warrants future investigations into the role of upfront adjuvant radiation therapy.

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Outcomes of hemi- versus whole liver transplantation in patients from mainland china with high model for end-stage liver disease scores: a matched analysis

BMC Surgery ◽

10.1186/s12893-020-00965-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

LingXiang Kong ◽

Tao Lv ◽

Li Jiang ◽

Jian Yang ◽

Jiayin Yang

Keyword(s):

Liver Transplantation ◽

Overall Survival ◽

Liver Disease ◽

Survival Data ◽

Demographic Data ◽

Meld Score ◽

End Stage Liver Disease ◽

Significant Difference ◽

End Stage ◽

Grade Iii

Abstract Background Adult hemiliver transplantation (AHLT) is an important approach given the current shortage of donor livers. However, the suitability of AHLT versus adult whole liver transplantation (AWLT) for recipients with high Model for End-Stage Liver Disease (MELD) scores remains controversial. Methods We divided patients undergoing AHLT and AWLT into subgroups according to their MELD scores (≥ 30: AHLT, n = 35; AWLT, n = 88; and < 30: AHLT, n = 323; AWLT, n = 323). Patients were matched by demographic data and perioperative conditions according to propensity scores. A cut-off value of 30 for MELD scores was determined by comparing the overall survival data of 735 cases of nontumor liver transplantation. Results Among patients with an MELD score ≥ 30 and < 30, AHLT was found to be associated with increased warm ischemia time, operative time, hospitalization time, and intraoperative blood loss compared with AWLT (P < 0.05). In the MELD ≥ 30 group, although the 5-year survival rate was significantly higher for AWLT than for AHLT (P = 0.037), there was no significant difference between AWLT and AHLT in the MELD < 30 group (P = 0.832); however, we did not observe a significant increase in specific complications following AHLT among patients with a high MELD score (≥ 30). Among these patients, the incidence of complications classified as Clavien-Dindo grade III or above was significantly higher in patients undergoing AHLT than in those undergoing AWLT (25.7% vs. 11.4%, P = 0.047). For the MELD < 30 group, there was no significant difference in the incidence of complications classified as Clavien-Dindo grade III or above for patients undergoing AHLT or AWLT. Conclusion In patients with an MELD score < 30, AHLT can achieve rates of mortality and overall survival comparable to AWLT. In those with an MELD score ≥ 30, the prognosis and incidence of complications classified as Clavien-Dindo III or above are significantly worse for AHLT than for AWLT; therefore, we may need to be more cautious regarding the conclusion that patients with a high MELD score can safely undergo AHLT.

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S-1/docetaxel compared with the other standard S-1 based regimens as a first-line chemotherapy for patients with advanced gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e15173 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e15173-e15173

Author(s):

Tetsuya Kusumoto ◽

Koji Ando ◽

Satoshi Ida ◽

Yasue Kimura ◽

Hiroshi Saeki ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Advanced Gastric Cancer ◽

Survival Data ◽

Objective Response ◽

The Other ◽

Phase Iii ◽

First Line ◽

Significant Difference ◽

Line Chemotherapy

e15173 Background: S-1 monotherapy or S-1/CDDP have remained important as a standard chemotherapy regimen for patients with advanced gastric cancer (AGC), based on the randomized phase III trials. Although S-1/docetaxel has been reported highly active and well tolerated for AGC by many researchers, it could not show the superiority compared with S-1 monotherapy in the recent international randomized trial. We have also demonstrated that it might be effective for patients with Stage III AGC in both preoperative and postoperative adjuvant setting. The aim of this study was to evaluate efficacy, toxicity and validity of S-1/docetaxel retrospectively, compared with the standard regimens. Methods: We conducted a retrospective review of the data of 89 patients with AGC who received chemotherapy who were given S-1-containing regimens as the first line chemotherapy; 15 patients treated with S-1 monotherapy, 21 with S-1/CDDP, and 53 with S-1/docetaxel. The objective response, adverse event (AE), progression-free survival (PFS), and overall survival (OS) were compared between the three groups. Results: The overall response rates (ORRs) were obtained 6.7%, 38.1% and 30.2% for S-1 monotherapy, S-1/CDDP, and S-1/docetaxel, respectively. The incidence of AEs was more frequent in S-1 based combined treatments than in the S-1 monotherapy, however there was no significant difference in the severe AEs between each group. Survival data showed that the PFSs were 121 days, 199 days and 178 days, respectively, and there was the significant difference between S-1 monotherapy and S-1/docetaxel (p<0.05). The overall survival showed that the MSTs were not significantly different. The conversion rate to the subsequent treatments following S-1 monotherapy was higher than the other treatments. Conclusions: S-1/docetaxel was active and well tolerated for the patients with ARGC as the first line. Although the Japanese guideline for treatment of gastric cancer recommends S-1 monotherapy or S-1/CDDP as the standard regimens, docetaxel could be applied for patients with AGC in case of CDDP-resistant or –naïve patients.

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Predictors of survival after trimodality therapy for esophageal adenocarcinoma: Analysis from the National Cancer Database.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.116 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 116-116

Author(s):

Oliver Eng ◽

Rebecca A. Nelson ◽

Joseph Chao ◽

Loretta Erhunmwunsee ◽

Dan Raz ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Adjuvant Chemotherapy ◽

Esophageal Adenocarcinoma ◽

Private Insurance ◽

Locally Advanced ◽

Cox Proportional Hazards Model ◽

Insurance Status ◽

National Cancer Database ◽

Trimodality Therapy

116 Background: Trimodality therapy with neoadjuvant chemoradiation followed by surgery has been shown to improve survival compared to surgery alone for the treatment of locally advanced esophageal cancer, but there is considerable variation in survival in this population. We sought to analyze factors associated with survival after trimodality therapy in esophageal adenocarcinoma. Methods: We identified 4,679 patients from the National Cancer Database (NCDB) who received chemotherapy and radiation prior to surgery for esophageal adenocarcinoma from 2006-2013. Patients with stage IV disease and unknown pathological nodal status were excluded. We performed a multivariate analysis using a Cox proportional hazards model to identify independent predictors of overall survival. Results: On multivariate analysis, pathologic characteristics associated with decreased overall survival included stage, lymphovascular invasion, and positive surgical margins. Insurance status, age, and comorbidity index were also associated with decreased survival. We found that patients treated at academic programs (HR 0.85, CI 0.78-0.92, p=0.0001) and those who received additional adjuvant chemotherapy had improved survival (HR 0.86, CI 0.75-1.00, p=0.0452), but the vast majority of patients receiving trimodality therapy (4,306; 92.0%) did not receive adjuvant chemotherapy. Patients who received adjuvant chemotherapy were more likely to have private insurance (69 vs. 53%, p<0.0001). Compared to private insurance, Medicaid (HR 1.43, CI 1.20-1.70, p<0.0001), Medicare (HR 1.21, CI 1.07-1.36, p=0.0026), or having no insurance (HR 1.49, CI 1.16-1.90, p=0.0015) were all negative predictors of overall survival. Conclusions: There is wide variation in survival following trimodality therapy for esophageal adenocarcinoma. Both tumor characteristics and patient characteristics play a role. Adjuvant chemotherapy appears to be associated with improved survival, but only a minority of patients receive adjuvant chemotherapy in this setting. Insurance status and treatment setting are independent predictors of overall survival after trimodality therapy and may indicate treatment disparities.

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Impact of no treatment vs other nonsurgical treatments in Pancreatic Adenocarcinoma National Cancer Database: 2004-2014.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15795 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15795-e15795

Author(s):

Sukamal Saha ◽

Mohamed Elgamal ◽

Meghan Cherry ◽

Robin Buttar ◽

Kiran Devisetty ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Pancreatic Adenocarcinoma ◽

Survival Data ◽

Radiation Treatment ◽

Chemoradiation Therapy ◽

National Cancer Database ◽

Chi Squared ◽

Impact On Survival ◽

Very High

e15795 Background: Surgery remains the only curative treatment option in pancreatic adenocarcinoma, yet in more than 50% of the patients (pts) the disease is too advanced or at very high risk and considered inoperable. They are either managed with no treatment or other nonsurgical methods. Hence, we analyzed a large cohort of pancreatic adenocarcinoma pts undergoing No Treatment vs Chemotherapy, Radiation or Chemoradiation to determine their impact on survival. Methods: Only pancreatic adenocarcinoma pts who had no surgery in the National Cancer Database (NCDB) from 2004–2014 were included. Of that group, patients with unknown or missing data about chemotherapy or radiation treatment or less than 3 years of survival data were excluded. Pts were stratified into 4 groups: Chemotherapy, Radiation Therapy, Chemoradiation and No Treatment. Overall 1-, 2- and 3-year survival was calculated and the groups were compared using Pearson’s chi-squared. Results: Of the total 309,709 pancreatic cancer pts in the NCDB 2004–2014, 111,421 (36.0%) remained after application of the study criteria. Of these, 43,203 (38.8%) received chemotherapy only, 2,453 (2.2%) received radiation only, 15,764 (14.1%) received chemoradiation and 50,001 (40.0%) had no treatment. Overall survival for 1, 2, and 3 years was best in the chemoradiation group with a 1 year survival of (40.0%) compared to chemotherapy only (22.4%), radiation only (14.9%) and no treatment (9.6%). Overall, only (19.0%) of pts survived for 1 year, (5.4%) survived for 2 years and (2.3%) survived for 3 years. (Table) Conclusions: Survival in pancreatic adenocarcinoma pts remains dismal without surgery. Best survival in nonsurgical pts was seen after combination Chemoradiation therapy and worst survival in No Treatment group. Hence, whenever possible, a combination Chemoradiation should be offered even as palliation in non-surgical pancreatic adenocarcinoma pts.[Table: see text]

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Treatment patterns and outcomes of locally advanced gall bladder cancer: A National Cancer Database (NCDB) analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e16147 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e16147-e16147

Author(s):

Pragnan Kancharla ◽

Lynna Alnimer ◽

Yazan Samhouri ◽

Karthik Shankar ◽

Veli Bakalov ◽

...

Keyword(s):

Overall Survival ◽

Gall Bladder ◽

Survival Data ◽

Treatment Modality ◽

Locally Advanced ◽

Treatment Patterns ◽

Treatment Selection ◽

Treatment Modalities ◽

Median Income ◽

Radiation Use

e16147 Background: Gall bladder (GB) cancer is rare but an aggressive disease especially when presenting at an advanced stage. There is controversy regarding the best treatment approach for locally advanced disease. In this NCDB analysis, we aim to study treatment patterns for T3, T4, and/or N1 GB cancer and estimate survival for each treatment modality. We also sought to investigate clinical and socioeconomic predictors of treatment selection. Methods: We conducted a retrospective cohort analysis using de-identified data accessed from the NCDB. The NCDB provided records of 39,229 patients diagnosed with GB cancer between 2004-2017. We excluded patients who were not treated at the reporting facility, those with no histologic confirmation of the diagnosis, those with no survival data available and those with T1, T2 and metastatic disease. We did exploratory analysis and divided patients into six arms based on treatment modality (Table). Stepwise multivariable regression models were used to analyze predictors of treatment selection. Survival estimates were calculated using the Kaplan Meier and proportional Cox hazard regression methods. Results: We identified 7,004 patients with GB cancer who fulfilled the inclusion and exclusion criteria. Median age was 68 years. There were 69.5% females, and the majority of patients were white (66.1%). Receiving treatment at an academic/research center (OR 0.37, 95% CI 0.19-0.73, p <0.01), black patients (OR 0.55 95% CI 0.36-0.85, p <0.01) and higher education (OR 0.58, 95% CI 0.37-0.91, p 0.02) decreased the odds of receiving surgery. Meanwhile, the presence of lymphovascular invasion was seen more amongst patients with receipt of surgery. For patients who underwent radiation, increasing age (OR 0.97, 95% CI 0.97-0.98, p <0.01) and higher histologic grade (OR 0.65, CI 0.46-0.92, p .02) were associated with less radiation use. Median income between $50,354-$63,332 (OR 1.28, 95% CI 1.02-1.60, p 0.04) was associated with more radiation use. Patient who received triple therapy had improved survival compared with other modalities (HR 0.51, CI 0.46-0.57, p <0.01). Median overall survival (OS) for the whole population was 13.0 months (CI 12.6-13.5) (Table) Conclusions: American patients with T3, T4, and/or N1 GB cancer received variable treatment modalities. Patients who underwent triple-modality therapy in our analysis had improved adjusted-overall survival compared with other modalities. Limitations include unmeasured confounding factors, selection bias and the retrospective design. We also identified clinical and socioeconomic factors that affect treatment selection.[Table: see text]

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Head and neck schwannomas – a 10 year review

The Journal of Laryngology & Otology ◽

10.1258/0022215001905058 ◽

2000 ◽

Vol 114 (2) ◽

pp. 119-124 ◽

Cited By ~ 153

Author(s):

M. P. Colreavy ◽

P. D. Lacy ◽

J. Hughes ◽

D. Bouchier-Hayes ◽

P. Brennan ◽

...

Keyword(s):

Overall Survival ◽

Adjuvant Therapy ◽

Head And Neck ◽

Treatment Modality ◽

Neck Region ◽

Surgical Excision ◽

Autonomic Nerve ◽

Benign Lesions ◽

Head And Neck Region

Schwannomas of the head and neck are uncommon tumours that arise from any peripheral, cranial or autonomic nerve. Twenty-five to 45 per cent of extracranial schwannomas occur in the head and neck region and thus are usually in the domain of the otolaryngologist. They usually present insidiously and thus are often diagnosed incorrectly or after lengthy delays, however, better imaging and cytological techniques have lessened this to some degree more recently. For benign lesions conservative surgical excision is the treatment of choice bearing in mind possible vagal or sympathetic chain injury. Malignant schwannomas are best treated with wide excision where possible. The role of adjuvant therapy remains uncertain and irrespective of treatment modality prognosis is poor with an overall survival of 15 per cent. However, recent advances in ras oncogene inhibitors may hold hope for the future.

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