Treatment trends in gastroesophageal and gastric cancers in the United States.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 136-136 ◽  
Author(s):  
Ali Mokdad ◽  
Amna Ali ◽  
Ibrahim Nassour ◽  
John C. Mansour ◽  
Sam C. Wang ◽  
...  
Keyword(s):  
United States ◽  
Metastatic Disease ◽  
Practice Patterns ◽  
Early Stage ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Multimodality Treatment ◽  
The United States ◽  
Distal Esophagus

136 Background: Randomized clinical trials reported in the last decade have helped define gastroesophageal junction (GEJ) and gastric cancer (GC) treatment. It is unclear, however, how practice patterns have evolved following these trials. This study explores the trends in treatment of GEJ and GC over the past decade in the United States. Methods: Patients with adenocarcinoma of the stomach and distal esophagus were identified in the National Cancer Database between 2006 and 2013. Tumor located in the distal esophagus and gastric cardia was denoted GEJ. Tumors distal to the cardia constituted GC. Tumors were categorized as early (Stage IA), locally advanced (IB-IIIC), and metastatic (IV). Detailed treatment was compared according to tumor stage and location. A time trend analysis was conducted. Results: A total of 120,729 patients (GEJ: 79,654 [66%], GC: 41,075 [34%]) were identified. Stage was similar in both groups (early: 12%, locally advanced: 55%, and metastatic: 33%). Overall, 73% of early GEJ and 74% of early GC underwent resection; of those, 43% and 12% were local excisions, respectively. Local excisions increased over time in both groups (annual odds ratio [OR] = 1.2; P < 0.01). In locally advanced GEJ, neoadjuvant chemoradiotherapy (CRT) increased among patients that received multimodality treatment (53% in 2006 to 73% in 2013; OR = 1.1, P < 0.01). In locally advanced GC, the use of neoadjuvant chemotherapy (CT) increased (5% to 20%; OR = 1.2, P < 0.01) as did perioperative CT (1% to 9%; OR = 1.3, P < 0.01) in lieu of adjuvant CRT (68% to 43%; OR = 0.9, P < 0.01). Multimodality treatment use remained stable over the study period in both groups (GEJ: 42%, GC: 47%). Among patients with metastatic disease, only 61% of GEJ and 40% of GC patients received CT, with 32% and 40%, respectively, not receiving any therapy at all. Conclusions: Practice patterns for GEJ and GC changed in the last decade with increasing adoption of neoadjuvant therapy in locally advanced disease and local excision of early stage cancers. Treatment for metastatic disease remains markedly underutilized, particularly GC.

scholarly journals Treatment Patterns for Gastroesophageal Junction Adenocarcinoma in the United States

2020 ◽  
Vol 9 (11) ◽  
pp. 3495
Author(s):  
Bradford J. Kim ◽  
Yi-Ju Chiang ◽  
Prajnan Das ◽  
Bruce D. Minsky ◽  
Mariela A. Blum ◽  
...  
Keyword(s):  
United States ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
The United States ◽  
Treatment Patterns ◽  
Disease Stage ◽  
Gastroesophageal Junction Adenocarcinoma ◽  
Prospective Trials ◽  
Age Range

Despite the increasing incidence of gastroesophageal junction adenocarcinoma (GEJA), the optimal treatment strategy for the disease remains unknown. The objective of this study was to describe treatment patterns for GEJA in the United States. The National Cancer Database was searched to identify all patients who underwent resection of the lower esophagus, abdominal esophagus, and/or gastric cardia for GEJA between 2006 and 2016. Patients were grouped by clinical disease stage: early localized (L; T1-2N0), locally advanced (LA; T3-4N0), regional (R; T1-2N+), or regionally advanced (RA; T3-4N+). The search identified 28,852 GEJA patients. The dominant age range was 60–69 years (39%). Most patients were men (85%), and most were white (92%). Most L patients (69%) underwent upfront surgery, whereas most LA, R, and RA patients received neoadjuvant therapy (NAT; 86%, 80%, and 90%, respectively). Among patients who received NAT, 85% received chemoradiotherapy. Adjuvant therapy was relatively uncommon across all groups (15–20%). In the LA, R, and RA groups, overall survival was greater in patients who received NAT compared to upfront surgery (p < 0.001). With the exception of patients with early localized node-negative disease, most GEJA patients receive neoadjuvant chemoradiotherapy despite the lack of prospective trials reporting survival benefit over chemotherapy alone.

Updates in the management and future landscape of urothelial carcinoma

2020 ◽  
pp. 107815522097102
Author(s):  
Kirollos S Hanna ◽  
Maren Campbell ◽  
Adam Kolling ◽  
Alex Husak ◽  
Sabrina Sturm ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Urothelial Carcinoma ◽  
Metastatic Disease ◽  
Checkpoint Inhibitors ◽  
Early Stage ◽  
Locally Advanced ◽  
The United States ◽  
Cancer Type ◽  
Antibody Drug Conjugate ◽  
Early Stage Disease

Urothelial carcinoma is the sixth most common cancer type in the United States. Although most patients present with early stage disease which is associated with improved outcomes, many will progress to locally advanced or metastatic disease. Immune checkpoint inhibitors have significantly impacted the treatment paradigm for patients and have resulted in improved survival rates. Despite their proven efficacy, many ongoing clinical trials continue to refine combinations with chemotherapy, sequencing of therapies and the role of ligand expression. Additionally, novel targets have been identified for advanced urothelial carcinoma and have led to the approval of the antibody-drug conjugate, enfortumab vedotin, and the fibroblast growth factor receptor-targeted, erdafitinib. Enrollment in a clinical trial is strongly encouraged for all stages of advanced or metastatic disease. Numerous ongoing clinical trials are likely to impact the treatment armamentarium for patients. In this manuscript, we highlight key updates in the clinical management for patients and outline ongoing trials.

Changing practice patterns of adjuvant radiation among elderly women with early stage breast cancer in the United States from 2004 to 2014

2020 ◽  
Vol 26 (3) ◽  
pp. 353-367 ◽  
Author(s):  
Sylvia A. Reyes ◽  
Austin D. Williams ◽  
Renee L. Arlow ◽  
Lucy M. De La Cruz ◽  
David N. Anderson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Practice Patterns ◽  
Elderly Women ◽  
Early Stage ◽  
The United States ◽  
Early Stage Breast Cancer ◽  
Adjuvant Radiation ◽  
Changing Practice

scholarly journals Opportunities for use of radiation therapy in penile cancer based on patterns of care in the United States from 2007 to 2013

2019 ◽  
Vol 11 ◽  
pp. 175628721982897 ◽  
Author(s):  
Xinglei Shen ◽  
William Parker ◽  
Leah Miller ◽  
Mindi TenNapel
Keyword(s):  
United States ◽  
Radiation Therapy ◽  
Squamous Cell ◽  
Penile Cancer ◽  
Early Stage ◽  
Locally Advanced ◽  
The United States ◽  
Adjuvant Radiation ◽  
Node Positive ◽  
Nodal Stage

Background: Radiation therapy (RT) is an effective modality for the treatment of squamous cell carcinomas of the penis. The National Comprehensive Cancer Network recommends consideration of primary radiation for penile preservation, in surgically unresectable tumors, and as adjuvant therapy for positive margins, bulky groin nodes or pelvic nodes. We performed a population-based analysis to evaluate the usage of RT in penile cancer from 2007 to 2013. Methods: We used the Surveillance, Epidemiology and End Results ( SEER) database to identify men diagnosed with squamous cell carcinoma of the penis from 2007 to 2013. Patients were grouped as early stage (T1–T2N0), locally advanced (T3–T4N0), node-positive (T1xN1–3) and metastatic. We used linear regression model to test for factors associated with adjuvant radiation in node-positive patients. Results: We identified 2200 men diagnosed with penile cancer between 2007 and 2013. Of these, 66.4% had early stage, 10.7% had locally advanced, 15.5% had node-positive, 3.2% had metastatic cancer. Among patient with early stage cancer, RT was used in 14 patients (1.0%) and postoperative radiation in an additional 45 patients (3.1%). Among 340 patients with node-positive cancer, 62.1% received surgery alone, 5.6% radiation alone, 21.8% surgery with adjuvant radiation, and 10.6% neither surgery nor radiation. Of patients who had surgery, 26.0% had adjuvant radiation. On univariate analysis, higher nodal stage (N2–3 versus N1) was associated with adjuvant radiation ( p = 0.02), while there was a trend for higher T-stage (T3/T4 versus T1/T2) ( p = 0.08) and history of prior malignancy ( p = 0.06). On multivariate analysis, only higher nodal stage (N2–3 versus N1) was associated with use of adjuvant radiation [hazard ratio (HR) 1.94, p = 0.03]. Conclusions: A small percentage of patient who are eligible for primary or adjuvant RT in the United States receive this treatment. Further work should be done to assess barriers to use of radiation in patients with penile cancer.

Preoperative imaging for staging of cutaneous melanoma in the United States: A population-based analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9034-9034 ◽  
Author(s):  
Dana Haddad ◽  
David Etzioni ◽  
Barbara A. Pockaj ◽  
Richard J. Gray ◽  
Nabil Wasif
Keyword(s):  
United States ◽  
Metastatic Disease ◽  
Cutaneous Melanoma ◽  
Early Stage ◽  
The United States ◽  
Preoperative Imaging ◽  
Advanced Imaging ◽  
Node Negative ◽  
Nccn Guidelines ◽  
T Classification

9034 Background: Routine imaging for staging of early stage cutaneous melanoma is not recommended by National Comprehensive Cancer Network (NCCN) guidelines. Besides the low probability of finding metastatic disease, detrimental aspects include false-positives and additive cost. We sought to investigate the use of imaging for staging of cutaneous melanoma in the United States. Methods: Patients with newly diagnosed clinically node negative cutaneous melanoma between 2000-2007 were identified from the Surveillance Epidemiology End Results-Medicare registry. Any imaging performed within 90 days following diagnosis was considered a staging study. Patients with metastatic disease were excluded. Results: A total of 25,643 patients were identified, of whom 10,775 (42%) underwent imaging. The mean age was 76.1 years, with the majority being male (61.8%) and Caucasian (98.4%). Breakdown by T classification of the primary was as follows: T1 (63%), T2 (17%), T3 (12%), and T4 (8%). A chest Xray was performed for 9,737 (38.0%), while 3,176 (12.4%) underwent advanced staging imaging studies; PET (7.2%), CT (5.9%), MRI (0.6%), and Ultrasound (0.4%). The use of advanced imaging steadily increased over the period of our study from 9.0% in 2000 to 16.3% in 2007 (p<0.001). When stratified by T classification, advanced imaging was used for 8.9% of T1, 14.5% of T2, 18.8% of T3 and 27.0% of T4 tumors (p<0.001). Similarly, node positive patients (4.7%) underwent advanced imaging 33.4% of the time compared to 11.3% for node negative patients (p<0.001). On multivariate analysis, factors predictive of advanced imaging include higher T classification (OR 3.12 T4 vs. T1, CI 2.77-3.52, p<0.001), node positivity (OR 2.70, CI 2.36-3.09, p<0.001), more recent year of diagnosis (OR 2.01 2007 vs. 2000, CI 1.71-2.37, p=0.006), high school education (OR 1.62, CI 1.43-1.83, p<0.001), non-Caucasian race (OR 1.37, CI 1.05-1.77, p=0.018), and male gender (OR 1.12, CI 1.03-1.21, p=0.006). Conclusions: Contrary to current recommendations, performance of advanced imaging for staging of early stage cutaneous melanoma is increasing in the Medicare population. Further research is needed to identify factors driving this increase.

scholarly journals Identification of Vulnerable Populations and Areas at Higher Risk of COVID-19-Related Mortality during the Early Stage of the Epidemic in the United States

2021 ◽  
Vol 18 (8) ◽  
pp. 4021
Author(s):  
Esteban Correa-Agudelo ◽  
Tesfaye B. Mersha ◽  
Adam J. Branscum ◽  
Neil J. MacKinnon ◽  
Diego F. Cuadros
Keyword(s):  
United States ◽  
Vulnerable Populations ◽  
Mortality Risk ◽  
Early Stage ◽  
The United States ◽  
National Average ◽  
Health Determinants ◽  
White Population ◽  
Latino Population ◽  
Related Mortality

We characterized vulnerable populations located in areas at higher risk of COVID-19-related mortality and low critical healthcare capacity during the early stage of the epidemic in the United States. We analyze data obtained from a Johns Hopkins University COVID-19 database to assess the county-level spatial variation of COVID-19-related mortality risk during the early stage of the epidemic in relation to health determinants and health infrastructure. Overall, we identified highly populated and polluted areas, regional air hub areas, race minorities (non-white population), and Hispanic or Latino population with an increased risk of COVID-19-related death during the first phase of the epidemic. The 10 highest COVID-19 mortality risk areas in highly populated counties had on average a lower proportion of white population (48.0%) and higher proportions of black population (18.7%) and other races (33.3%) compared to the national averages of 83.0%, 9.1%, and 7.9%, respectively. The Hispanic and Latino population proportion was higher in these 10 counties (29.3%, compared to the national average of 9.3%). Counties with major air hubs had a 31% increase in mortality risk compared to counties with no airport connectivity. Sixty-eight percent of the counties with high COVID-19-related mortality risk also had lower critical care capacity than the national average. The disparity in health and environmental risk factors might have exacerbated the COVID-19-related mortality risk in vulnerable groups during the early stage of the epidemic.

Current practice patterns for management of vulvodynia in the United States

2016 ◽  
Vol 295 (3) ◽  
pp. 669-674 ◽  
Author(s):  
Lannah L. Lua ◽  
Yvette Hollette ◽  
Prathamesh Parm ◽  
Gayle Allenback ◽  
Vani Dandolu
Keyword(s):  
United States ◽  
Current Practice ◽  
Practice Patterns ◽  
The United States
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