A population-based study of factors associated with post-prostatectomy radiation therapy utilization.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 182-182
Author(s):  
Matthew J. Maurice ◽  
Hui Zhu ◽  
Robert Abouassaly
Keyword(s):  
Radiation Therapy ◽  
Gleason Score ◽  
Strong Predictor ◽  
Teaching Hospitals ◽  
Time Range ◽  
Adjuvant Radiation ◽  
Cancer Society ◽  
Positive Margins ◽  
Pathologic Features ◽  
To Receive

182 Background: Based on level one evidence, adjuvant radiation therapy (aRT) improves cancer control in post-prostatectomy patients with adverse pathologic features. We sought to evaluate its utilization and to identify factors affecting of its use. Methods: Using the National Cancer Database, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, we identified men diagnosed with prostate cancer between 2004 and 2011 who were found to have pT3 disease or pT2 disease with positive margins following prostatectomy. We defined aRT as radiation to the prostate and/or pelvis 6 months or less after prostatectomy. We then used univariate and multivariate logistic regression models to assess potential patient and provider predictors of aRT use. Results: We evaluated 103,092 men who had either pT3 disease (81%) or pT2 with positive margins (19%). Of these, we identified 10,043 men (9.7%) who received aRT. Since 2004, there has been a steady decline in aRT usage with time (range, 11.5% to 7.8%). Compared to 2004, patients diagnosed in 2011 were significantly less likely to receive aRT (odds ratio [OR] 0.78, confidence interval [CI] 0.71-0.85, p<0.0001). Higher Gleason score and T stage were strongly associated with positive aRT utilization (p<0.0001), while increasing age was associated with decreased use (p<0.0001). Another strong predictor of aRT uptake was hospital type. Compared to patients treated at community hospitals, patients treated at comprehensive cancer centers or teaching hospitals were significantly less likely to receive aRT (OR 0.63, 0.58-0.68, p<0.0001 or OR 0.42, CI 0.39-0.46, p<0.0001, respectively). Charlson score and hospital location were significantly but weakly associated with aRT. Other demographic variables were not predictive of aRT. Conclusions: Post-prostatectomy aRT use is declining despite clear proof of its benefit. Consistent with the evidence, patients with risk factors for biochemical relapse (i.e. high Gleason score or T3 disease) and younger patients, who are more likely to benefit, are receiving aRT. Surprisingly, aRT use is lower at teaching hospitals, which may reflect higher usage of salvage radiation.

Do urologists and radiation oncologists agree on adjuvant radiation therapy for prostate cancer? A web-based patterns-of-care survey.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 76-76
Author(s):  
T. N. Showalter ◽  
K. A. Teti ◽  
K. A. Foley ◽  
S. W. Keith ◽  
E. J. Trabulsi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Gleason Score ◽  
Positive Surgical Margin ◽  
Adjuvant Radiation ◽  
Biochemical Control ◽  
Web Based ◽  
Adjuvant Radiation Therapy ◽  
Radiation Oncologists ◽  
Pathologic Features

76 Background: Three randomized trials support adjuvant radiation therapy (ART) over observation after radical prostatectomy (RP) for prostate cancer (PC) patients with adverse pathologic features (APFs), but many clinicians instead favor early salvage RT (SRT) for a rising PSA. We conducted a web-based survey of U.S. radiation oncologists (RO) and urologists (U) regarding ART and SRT. Methods: We designed a web-based survey to evaluate beliefs about post-RP RT and treatment policies. Survey invitations were e-mailed to SUO members and a list of 926 RO ASTRO members with an interest in PC. One email was sent to limit message burden. Only those responses at least 50% complete were included in the analysis. Differences in ART recommendation rates were evaluated by chi square test. Results: Responses were received from 231 RO and 101 U, resulting in 302 analyzable responses (88 U, 214 RO). 79% of U and 32% of RO respondents were academic physicians. ART was recommended based on APF alone (78% RO, 44% U), based on APF plus Gleason score or PSA (14% RO, 35% U), only for detectable PSA (7% RO, 14% U), or never (2% RO, 7% U). When asked the effect of ART on outcomes, most respondents replied “improves survival” (71% RO, 63% U) or “improves biochemical control but not survival” (29% RO, 30% U), but 9% of U replied “delays PSA recurrence, but no durable benefit” or “no improvement in any outcomes” (versus 0% RO). A recommendation for ART based on APFs alone was made for: seminal vesicle invasion (SVI) (76% RO, 59% U; p=0.003), extracapsular extension (ECE) (70% RO, 32% U; p<0.001), positive surgical margin (PSM) (91% RO, 48% U; p<0.002). For patients with Gleason score 8-10 PC, ART was recommended for: SVI (75% RO, 56% U; p=0.001), ECE (73% RO, 45% U; p<0.001), PSM (93% RO, 74% U; p<0.001). Reported PSA threshold for SRT was: any detectable (36% RO, 23% U), 0.2-0.3 (50% RO, 36% U), 0.4-0.5 (9% RO, 30% U), 0.6-0.8 (3% RO, 10% U) ng/mL, or higher (1% RO, 1% U). Conclusions: Despite similar rates of belief that ART improves survival or biochemical control, U were less likely than RO to recommend ART based solely on APFs after RP. Upcoming results of clinical trials of ART versus SRT may provide consensus for decisions in this setting. No significant financial relationships to disclose.

Surgical management versus combination radiotherapy in Gleason score 9-10 prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 135-135 ◽  
Author(s):  
Edward Christopher Dee ◽  
Martin T. King ◽  
Santino Butler ◽  
Zizi Yu ◽  
Sybil Sha ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Surgical Management ◽  
Gleason Score ◽  
Patient Selection ◽  
External Beam Radiation ◽  
Patient Specific ◽  
Adjuvant Radiation ◽  
Beam Radiation ◽  
Pathologic Features

135 Background: For men with Gleason score 9-10 prostate cancer, studies have demonstrated conflicting results on the outcomes from combination radiation therapy (ComboRT) with external beam radiation therapy plus brachytherapy boost versus radical prostatectomy (RP), with or without adjuvant radiation therapy (ART). Differences in patient selection and management may explain some of the disparate outcomes of prior reports. Methods: The Surveillance, Epidemiology, and End Results database identified 10,396 men managed with ComboRT versus RP (+/-ART). Competing-risks regression analysis with treatment propensity adjustment defined hazard ratios (aHR) for prostate cancer-specific mortality (PCSM), controlling for patient-specific demographic factors. To explore the possible effect of patient selection, analyses were conducted before and after excluding men from analysis if they had evidence-based indications for ART (adverse pathology, i.e. pT3-T4 or positive margins) but did not receive it. Results: Median age was 64 years; median follow-up was 69 months. Five-year PCSM was similar between patients treated with RP (with or without ART, regardless of pathologic features, N=8,934) and ComboRT (N=1,462) (6.9% vs 8.1%, aHR=0.94, 95% confidence interval [CI] 0.78–1.13, P=0.51). After excluding RP-treated men with adverse pathology who did not receive ART (N=4,527 excluded), patients treated with RP+/-ART (N=4,407) had improved 5-year PCSM compared with those treated with ComboRT (5.3% vs 8.1%, aHR=0.74, 95% CI 0.60–0.91, P=0.004). Conclusions: For Gleason 9-10 prostate cancer, ComboRT was associated with similar PCSM compared to RP, but risk-tailored surgical management may be associated with superior PCSM.

Can post-operative prostate fossa radiation be omitted in patients with high-risk features using a genomic classifier?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 101-101
Author(s):  
Joseph Anthony Marascio ◽  
Matthew Bloom ◽  
Mark Hurwitz ◽  
Leonard G. Gomella ◽  
Costas D. Lallas ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Progression Free Survival ◽  
Biochemical Failure ◽  
Genomic Testing ◽  
Adjuvant Radiation ◽  
Positive Margins ◽  
Salvage Radiation Therapy ◽  
Pathologic Features ◽  
Pre Treatment

101 Background: At our institution, based upon the AUA/ASTRO guidelines, discussion of adjuvant radiation therapy (ART) for patients with adverse pathologic features (APF) (pT3/positive margins) occurs in a multidisciplinary setting. We had previously offered ART to approximately 50% of these patients. We describe our evaluation of Decipher genomic testing to select patients to offer observation following prostatectomy (RP). Methods: Since March 2014, patients at Thomas Jefferson University with APF and undetectable post-operative PSA underwent Decipher genomic testing. Collectively, we decided to offer observation with salvage radiation therapy (SRT) for patients with low or intermediate risk Decipher scores. The primary outcome of this analysis was biochemical progression free survival (bPFS) with failure defined as a PSA ≥0.1 ng/mL. Results: From March of 2014 through September of 2016, 47 patients met the above criteria. The median patient age was 64 and median follow up was 16 months. Median pre-treatment PSA was 6.0 ng/mL (2.94 to 22.7 ng/mL). With regard to pathologic stage: 19% had T2c, 68% had T3a, and 13% had T3b disease. Pathologic Gleason grouping was 6%, 49%, 34%, 6%, and 4% for groups 1-5, respectively. 51% of patients had positive margins, 36% had lymph-vascular space invasion, and 53% had perineural invasion. Four patients received ART and 1 patient was lost to follow up after his initial visit. Of the remaining 42 patients, 3 patients experienced biochemical failure at 8, 27, and 44 months. Conclusions: This is the first prospective report utilizing Decipher genomic testing to stratify men with undetectable PSA and adverse pathologic features into an observation cohort following RP. Despite the stringency of our definition of biochemical failure, our observed bPFS was 87% at 3 years. Historically, in an unselected population the 3 year bPFS was 90% in those receiving ART and 65% in those receiving SRT. While these initial findings are promising, longer follow up is warranted. Our findings demonstrate the utility of genomic classifiers in patient selection and provide a safe approach to reducing over treatment in the post RP setting.

Redefining the role of adjuvant versus salvage radiation therapy for prostate cancer after radical prostatectomy for T3 disease and/or positive margins.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 367-367
Author(s):  
Barry W. Goy ◽  
In-Lu Amy Liu
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Hormonal Therapy ◽  
Salvage Therapy ◽  
Low Risk ◽  
Adjuvant Radiation ◽  
Positive Margins ◽  
Salvage Radiation Therapy

367 Background: SWOG 8794 recommends adjuvant radiation therapy (ART) after radical prostatectomy (RP) for T3 and/or positive margins. Our purpose was to assess 12-year outcomes on 862 RP patients who had either T3 and/or positive margins who underwent surveillance, salvage radiation therapy (SRT), or hormonal therapy (HT), while categorizing these patients into very low risk (VLR), low risk (LR), high risk (HR), and ultra high risk (UHR) groups. Methods: From 2004 - 2007, 862 RP patients had adverse factors of extracapsular penetration (T3a), seminal vesicle invasion (T3b), positive margins, and/or detectable post-operative PSA. Management included surveillance (54.8%), SRT (36.8%), and HT (8.5%) as first salvage therapy, and 21.5% eventually received hormonal therapy. Twenty patients underwent ART, and were excluded from this analysis. We assessed prognostic factors using multivariable analysis, and 12-year estimates of freedom from biochemical failure (FFBF), freedom from salvage therapy (FFST), distant metastases-free survival (DMFS), prostate cancer-specific survival (PCSS), and overall survival (OS). VLR were those with Gleason Score (GS) of 6. LR were GS 3+4 with only T3a or positive margins, but an undetectable postoperative PSA <0.1. HR were T3b with GS 7-10, any GS 7-10 with T3a/b and positive margins, but an undetectable PSA. UHR were those with a detectable PSA with a GS 7-10. Results: Median follow-up was 12.1 years. Median age was 61.6 years. Median time to first salvage treatment for VLR, LR, HR, and UHR were 10.8, 11.1, 5.3, and 0.6 years, p<0.001. 12-year estimates of FFBF for VLR, LR, HR, and UHR were 60.2%, 52.9%, 28.4%, and 0%, p<0.0001. For FFST, 70.9%, 68.6%, 40.5%, and 0%, p<0.0001. For DMFS, 99.1%, 97.8%, 88.6%, and 63.6%, p<0.0001. For PCSS, 99.4%, 99.5%, 93.5%, and 78.9%, p<0.0001. For OS, 91.8%, 91.8%, 81.0%, and 69.9%, p<0.0001. Conclusions: Outcomes of T3 and/or positive margins using surveillance or SRT as initial management yields excellent outcomes for VLR and LR groups, in which ART should be avoided. For HR, ART can be considered reasonable, since FFBF is only 28.4%. For VHR, these patients may benefit from combined hormonal therapy and ART.

Efficacy of early and delayed radiation in a prostatectomy cohort adjusted for genomic and clinical risk.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 12-12
Author(s):  
Robert Den ◽  
Kasra Yousefi ◽  
Bruce J. Trock ◽  
Elai Davicioni ◽  
Jeffrey J. Tosoian ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Therapy ◽  
Oncologic Outcomes ◽  
Adjuvant Radiation ◽  
Salvage Radiation Therapy ◽  
Pathologic Features ◽  
The Impact ◽  
Genomic Risk ◽  
Clinical Genomic

12 Background: In 3 published randomized trials, adjuvant radiation therapy (ART) for prostate cancer (PCa) resulted in improved progression free survival. However, the impact on metastases and overall survival is unclear. To date, there have been no published prospective trials examining the impact of salvage radiation therapy (SRT) in this disease state. Hence, we conducted a retrospective, nonrandomized comparative study of ART, SRT, or no radiation following radical prostatectomy (RP) for men with pT3 disease or positive margins (adverse pathologic features, APF). Methods: 422 PCa men treated at 4 institutions with RP and having APF were analyzed with a primary end point of clinical metastasis. ART (n = 111), early SRT (n = 70) and delayed SRT (n = 83) were defined by PSA levels of < 0.2, 0.2 to 0.5, and ≥ 0.5 ng/mL, respectively, prior to RT initiation. Remaining 157 men who did not receive additional therapy prior to metastatic onset formed the no RT arm. Clinical-genomic risk was assessed by CAPRA-S and Decipher. Cox multivariable (MVA) model was used to evaluate the impact of treatment on outcome. Results: During study follow-up, 37 men developed metastasis with a median follow-up of 8 years. Both CAPRA-S and Decipher had independent predictive value on MVA for metastatic outcome (both p < 0.05). On MVA adjusting for clinical-genomic risk, delayed SRT and no RT had an HR of 4.31 (95%CI, 1.20-15.47) and 5.42 (95% CI, 1.59-18.44) for metastasis compared to ART. No significance difference was observed between early SRT and ART (p = 0.28). Men with low to intermediate CAPRA-S and low Decipher have a low rate of metastatic events regardless of treatment selection. In contrast, men with high CAPRA-S and Decipher benefit from ART, however the cumulative incidence of metastasis remains high. Conclusions: The decision as to the timing and need for additional local therapy following RP is nuanced and requires providers and men to balance risks of morbidity with improved oncologic outcomes. This analysis provides the most robust and accurate quantification of risk for these men. Post-RP treatment can be safely avoided for men who are low risk by clinical-genomic risk, whereas those at high risk should favor enrollment in clinical trials.

A phase III trial to compare atezolizumab (atezo) vs best supportive care (BSC) following adjuvant chemotherapy in patients (pts) with completely resected NSCLC: IMpower010.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS8576-TPS8576 ◽  
Author(s):  
Heather A. Wakelee ◽  
Nasser K. Altorki ◽  
Eric Vallieres ◽  
Caicun Zhou ◽  
Yunxia Zuo ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Tumor Resection ◽  
Disease Free Survival ◽  
Phase Iii ◽  
Disease Stage ◽  
Adjuvant Radiation ◽  
Stage Ib ◽  
Resected Nsclc ◽  
Iiia Nsclc ◽  
To Receive

TPS8576 Background: The anti–PD-L1 mAb atezo blocks the interaction between PD-L1 and its receptors PD-1 and B7.1 and restores anti-tumor immunity. In the OAK trial, pts with 2L/3L advanced NSCLC had improved mOS in the atezo arm (13.8 mo) vs the docetaxel (doc) arm (9.6 mo), with a survival benefit observed regardless of PD-L1 expression levels on tumor cells (TC) or tumor-infiltrating immune cells (IC). However, more effective treatment options are needed for pts with early-stage NSCLC. A global Phase III, randomized, open-label trial, IMpower010 (NCT02486718), is being conducted to evaluate the efficacy and safety of atezo vs BSC following adjuvant cisplatin (cis)–based chemotherapy (chemo) in pts with resected stage IB (tumors ≥ 4 cm)-IIIA NSCLC. Methods: Pts eligible for study must have complete tumor resection 4 to 12 weeks prior to enrollment for pathologic stage IB (tumors ≥ 4 cm)-IIIA NSCLC, be adequately recovered from surgery, be able to receive cis-based adjuvant chemo and have an ECOG PS 0-1. Pts with other malignancies, autoimmune disease, hormonal cancer or radiation therapy within 5 years and prior chemo or immunotherapy are excluded from study. Approximately 1127 pts will be enrolled regardless of PD-L1 status. Pts will receive up to four 21-d cycles of cis-based chemo (cis [75 mg/m2 IV, d 1] + vinorelbine [30 mg/m2 IV, d 1, 8], doc [75 mg/m2 IV, d 1] or gemcitabine [1250 mg/m2 IV, d 1, 8], or pemetrexed [500 mg/m2 IV, d 1; only non-squamous NSCLC]). No adjuvant radiation therapy is permitted. After adjuvant chemo, eligible pts will be randomized 1:1 to receive 16 cycles of atezo 1200 mg q3w or BSC. Stratification factors include sex, histology (squamous vs non-squamous), disease stage (IB vs II vs IIA) and PD-L1 status by IHC (TC2/3 [≥ 5% expressing PD-L1] and any IC vs TC0/1 [ < 5%] and IC2/3 vs TC0/1 and IC0/1 [ < 5%]). The primary endpoint is disease-free survival; secondary endpoints include OS and safety. Exploratory biomarkers, including PD-L1 expression, immune- and tumor-related biomarkers before, during and after treatment with atezo and at radiographic disease recurrence, or confirmation of new primary NSCLC, will be evaluated. Clinical trial information: NCT02486718.

Desmoid Tumor: Prognostic Factors and Outcome After Surgery, Radiation Therapy, or Combined Surgery and Radiation Therapy

1999 ◽  
Vol 17 (1) ◽  
pp. 158-158 ◽  
Author(s):  
Matthew T. Ballo ◽  
Gunar K. Zagars ◽  
Alan Pollack ◽  
Peter W.T. Pisters ◽  
Raphael A. Pollock
Keyword(s):  
Radiation Therapy ◽  
Relapse Rate ◽  
Desmoid Tumor ◽  
Survival Rates ◽  
Adverse Impact ◽  
Adjuvant Radiation ◽  
Desmoid Tumors ◽  
Positive Margins ◽  
Potential Benefits ◽  
Relapse Rates

PURPOSE: To evaluate the therapeutic value of resection and the potential benefits of and indications for adjuvant and definitive radiation therapy for desmoid tumors. MATERIALS AND METHODS: We performed a retrospective review of 189 consecutive cases of desmoid tumor treated with surgical resection, resection and radiation therapy, or radiation therapy alone. Treatment was surgery alone in 122 cases, surgery and radiation therapy in 46, and radiation therapy alone in 21. Median follow-up was 9.4 years. RESULTS: Overall, 5- and 10-year actuarial relapse rates were 30% and 33%, respectively. Uncorrected survival rates were 96%, 92%, and 87% at 5, 10, and 15 years, respectively. For the patients treated with surgery, the actuarial relapse rates were 34% and 38% at 5 and 10 years, respectively. Among 78 patients with negative margins, the 10-year recurrence rate was 27%, whereas 40 margin-positive patients had a 10-year relapse rate of 54% (P = .003). Tumors located in an extremity also had a poorer prognosis than did those in the trunk. For patients treated with radiation therapy for gross disease, the 10-year actuarial relapse rate was 24%. For patients treated with combined resection and radiation therapy, the 10-year actuarial relapse rate was 25%. The addition of radiation therapy offset the adverse impact of positive margins seen in the surgical group. CONCLUSION: Wide local excision with negative pathologic margins is the treatment of choice for most desmoid tumors. Function-sparing resection is appropriate because adjuvant radiation therapy can offset the adverse impact of positive margins. Unresectable disease should be treated with definitive radiation therapy.

Identification of Factors Predicting Response to Adjuvant Radiation Therapy in Patients With Positive Margins After Radical Prostatectomy

2003 ◽  
Vol 170 (5) ◽  
pp. 1860-1863 ◽  
Author(s):  
ASHISH M. KAMAT ◽  
KARA BABAIAN ◽  
MIN REX CHEUNG ◽  
YOSHIO NAYA ◽  
SAMUEL H. HUANG ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Positive Margins

Surgery and adjuvant therapy in gallbladder cancer: A single-institution experience.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 405-405
Author(s):  
Nishi Kothari ◽  
Richard D. Kim ◽  
Gregory M. Springett ◽  
Sarah E. Hoffe ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Adjuvant Therapy ◽  
Gallbladder Cancer ◽  
Early Stage ◽  
High Rate ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Positive Margins ◽  
Radical Cholecystectomy ◽  
Biomarker Analysis

405 Background: Gallbladder cancer is a highly fatal disease with a high rate of recurrence even when diagnosed at an early stage. Because of its relative rarity, there are currently no established algorithms to guide therapy after cholecystectomy. To explore the value of adjuvant therapy with chemotherapy and radiation, we evaluated patients with resected gallbladder cancer treated at our institution. Methods: Patients diagnosed with gallbladder cancer who underwent cholecystectomy (simple or radical) between 2000 and 2010 were identified using our cancer registry. Retrospective chart review was performed for clinicopathologic data, including age, stage, grade, type of surgery, margin status, and type and duration of adjuvant therapy. The primary endpoint was overall survival (OS). Univariate (UVA) and multivariate (MVA) analysis was performed with Cox logistic regression analyses. Results: We identified 73 patients with a median followup for all patients of 28.2 months. The majority of patients were female (74%) and underwent radical cholecystectomy (64%). Positive margins and adjuvant radiation therapy were documented in 21% and 37%, respectively. The majority of patients did not receive any adjuvant therapy (53.4%). Median OS for all patients was 41.3 months. There was a survival benefit associated with patients undergoing radical cholecystectomy followed by adjuvant radiation (median OS 48.4 months vs. 22.3 months; HR 0.35; 95% CI: 0.13–0.98; p=0.0448) compared to simple cholecystectomy alone. On UVA, increasing age and positive margins were significantly associated with worse OS, while radical cholecystectomy was associated with improved OS. On MVA, increasing age, male gender, poorly differentiated tumor, and positive margins were associated with worse OS, while adjuvant radiation was associated with improved OS (p=0.0113). Conclusions: Our analysis supports the role for adjuvant radiation therapy in resected gallbladder cancer. Multi-institutional prospective studies should be performed to evaluate the optimal treatment strategy. Biomarker analysis might also help determine the subset of patients who would benefit from combined chemoradiation.

Effects of adjuvant radiation therapy on survival for patients with resected primary tracheal carcinoma: an analysis of the National Cancer Database

2019 ◽  
Vol 49 (7) ◽  
pp. 628-638 ◽  
Author(s):  
Mehran Yusuf ◽  
Jeremy Gaskins ◽  
Emma Trawick ◽  
Paul Tennant ◽  
Jeffrey Bumpous ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Cox Regression ◽  
Surgical Margin ◽  
Surgical Margins ◽  
Adjuvant Radiation ◽  
National Cancer Database ◽  
Adjuvant Radiation Therapy ◽  
Immortal Time Bias ◽  
The Impact ◽  
To Receive

Abstract Objective(s) To identify predictors for receiving adjuvant radiation therapy (RT) and investigate the impact of adjuvant RT on survival for patients with resected primary tracheal carcinoma (PTC). Methods The National Cancer database was queried for patients with PTC diagnosed from 2004 to 2014 undergoing resection. Patients who died within 30 days of resection were excluded to minimize immortal time bias. Kaplan–Meier methods, Cox regression modeling and propensity score weighted (PSW) log-rank tests were considered to assess the relationship between adjuvant RT and overall survival (OS). Logistic regression was performed to identify predictors associated with receiving adjuvant RT. Results A total of 549 patients were identified with 300 patients (55%) receiving adjuvant RT. Squamous cell carcinoma (SCC) was the most common histology with 234 patients (43%). Adenoid cystic carcinoma (ACC) was second most frequent with 180 patients (33%). Adjuvant RT was not associated with OS by multivariable Cox analysis or PSW log-rank test (P values > 0.05). Patients with positive surgical margins (odds ratio (OR) 1.80, confidence interval (CI) 1.06–3.07) were more likely to receive adjuvant RT than those with negative surgical margins. Patients with ACC (OR 6.53, CI 3.57–11.95) were more likely to receive adjuvant RT compared with SCC. Conclusions Adjuvant RT was not significantly associated with OS for patients with resected PTC in this analysis. Surgical margin status and tumor histology were associated with receiving adjuvant RT. Further investigations including prospective registry studies capturing radiation technique and treatment volumes are needed to better define which patients with resected PTC may benefit from adjuvant RT.

Sign in / Sign up

Export Citation Format

Share Document