Comparison of outcomes in patients with locally advanced pancreatic adenocarcinoma treated with stereotactic body radiation therapy (SBRT) versus conventionally fractionated radiation: An analysis of the National Cancer Database.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 366-366
Author(s):  
Jim Zhong ◽  
Kirtesh R. Patel ◽  
Jeffrey M. Switchenko ◽  
Theresa Wicklin Gillespie ◽  
Richard John Cassidy ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Advanced Pancreatic Cancer ◽  
Rank Test ◽  
National Cancer Database ◽  
Fractionated Radiation ◽  
Conventionally Fractionated

366 Background: As systemic therapy has improved for locally advanced pancreatic cancer (LAPC), efforts to improve local control have become critical. While conventionally fractionated radiation therapy (CFRT) has more recently shown a limited role in LAPC, stereotactic body irradiation (SBRT) is an emerging approach that delivers higher doses of radiation therapy, to small volumes, over a much shorter period of time. With no studies to date comparing SBRT to CFRT for LAPC, we utilized the National Cancer Database (NCDB) to evaluate these two modalities. Methods: Using the NCDB, patients with AJCC clinic cT2-4, N0-1, M0 adenocarcinoma of the pancreas diagnosed from 2004-2013 were analyzed. Radiation therapy delivered at 2 Gy per fraction or less was deemed CFRT, and 4 Gy or more per fraction was considered SBRT to allow inclusion of practice variations. Kaplan-Meier, log-rank test, and multivariable Cox proportional hazards regression were performed with overall survival (OS) as the primary outcome. Propensity score matching was employed to reduce treatment selection bias. Results: Among 8,450 patients, 7,819 (92.5%) were treated with CFRT, and 631 (7.5%) underwent SBRT. The median dose per fraction and number of fractions for CFRT and SBRT cohorts were 1.8 Gy per fraction in 28 fractions and 8 Gy per fraction in 5 fractions, respectively. Using propensity score matching, 988 patients were matched, with 494 patients in each cohort. Within the propensity-matched cohorts, the median OS was higher with SBRT (13.9 vs. 10.7 months), and 2-year OS of 21.5% and 15.9% for the SBRT and CFRT groups, respectively ( p = 0.0014). Multivariable analysis confirmed SBRT was a significant predictor for OS (Hazard ratio:0.84; 95% confidence interval: 0.75-0.93, p = 0.001). Additionally, pancreatoduodenectomy, low comorbidity index, chemotherapy use, and node negative disease also positively impacted survival. Conclusions: SBRT appears to be associated with an improved OS compared to CFRT for LAPC. Further prospective studies investigating these hypothesis-generating results are warranted.

Outcomes of pancreatic ductal adenocarcinoma (PDAC) patients treated with neoadjuvant stereotactic body radiation therapy (SBRT) or conventionally fractionated radiation therapy (CFRT).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16209-e16209
Author(s):  
Fan Zhu ◽  
Haoyu Wang ◽  
Hani Ashamalla
Keyword(s):  
Radiation Therapy ◽  
Lymph Nodes ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Ductal Adenocarcinoma ◽  
Rank Test ◽  
Survival Difference ◽  
Multi Agent ◽  
Fractionated Radiation ◽  
Conventionally Fractionated

e16209 Background: Hypothesis: Neoadjuvant SBRT can improve survival when compared to CFRT in PDAC patients who received chemotherapy. Past retrospective studies have shown improved outcomes of definitive SBRT when compared to CFRT without accounting for chemotherapy.1 We aim to study the outcomes of neoadjuvant SBRT vs CFRT accounting for chemotherapy. Methods: The National Cancer Database (NCDB) was queried for cases of PDAC from 2004-2015. Patients who received surgery and chemotherapy were included. Exclusion criteria were prior hormonal therapy or immunotherapy, lack of pathological confirmation or lack of information about chemotherapy. Log-rank test and Cox proportional hazards model were used to compare survival by radiation modalities. Predictors for overall survival (OS) were identified. Propensity score-matched (PSM) analysis balancing for different variables including type of chemotherapy was conducted. Results: Among 1604 patients, 223 (13.9%) had SBRT, and 1381 (86.1%) had CFRT. The median survivals were 30.0 and 26.0 months ( P = 0.010), while the 2-year survival rates were 63.4% and 53.7% for SBRT and CFRT patients, respectively. SBRT tended to be offered to older patients (age≥65: 56.1% vs 47.3%, P = 0.018), healthier patients (CCI=0: 72.2% vs 63.6%, P = 0.016), patients with worse cT staging (cT3 and cT4: 80.7% vs 69.7%, P = 0.008) and patients who got more multi-agent chemotherapy (89.2% vs 50.5%, P < 0.001). In the cohort with positive clinical lymph nodes (cN+), CFRT tended to decrease the pN staging more when compared to SBRT ( P = 0.032) (Table). In multivariate analysis, multi-agent chemotherapy (HR, 0.72; P < 0.001) was associated with better OS. SBRT did not show significantly better OS when compared to CFRT (HR, 0.81; P = 0.13) after accounting for other covariates including chemotherapy. PSM (1:1 match) analysis matched 223 pairs. SBRT did not show significant OS benefit (HR, 0.80; P = 0.17) when compared to CFRT. Conclusions: SBRT may be superior to CFRT in univariate analysis. However, after accounting for multi-agent chemotherapy, there is no significant survival difference between neoadjuvant SBRT and CFRT. Studies with larger sample size are desired. Neoadjuvant CFRT offers more significant nodal down-staging in patients with clinically positive lymph nodes (cN+) when compared to SBRT. Reference: Zhong J, Patel K, Switchenko J, et al. Outcomes for patients with locally advanced pancreatic adenocarcinoma treated with stereotacticbody radiation therapy versus conventionally fractionated radiation. Cancer2017 Sep 15;123(18):3486-3493. pN staging of cN+ cohort[Table: see text]

Outcome analysis of chemotherapy duration for resected stage I-II and unresected stage III pancreatic cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 375-375
Author(s):  
Sung Jun Ma ◽  
Austin J Iovoli ◽  
Kavitha M Prezzano ◽  
Gregory Hermann ◽  
Lucas M Serra ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Advanced Pancreatic Cancer ◽  
Stage I ◽  
Stage Iii ◽  
Outcome Analysis ◽  
Resected Stage

375 Background: For resected early-stage pancreatic cancer, RTOG 9704 has evaluated the outcome of 3 weeks of adjuvant chemotherapy (C) followed by chemoradiation (CRT) and post-CRT C. For locally advanced pancreatic cancer, a recent literature review showed that the typical duration for induction C is between 1 and 6 months prior to CRT. The ideal duration of C prior to CRT remains unclear. This National Cancer Database (NCDB) study was performed to identify the optimal duration of C prior to CRT in patients with pancreatic cancer. Methods: The NCDB was queried for primary stage I-II, cT1-3N0-1M0, resected and stage III, cT4N0-1M0, unresected pancreatic adenocarcinoma treated with C+CRT (2004-2015). Cohorts I-II and III included stage I-II and stage III cases, respectively. In each cohort, the patients were stratified by the short (short C) and long duration (long C) of chemotherapy based on their median durations (70 and 90 days between the onset of chemotherapy and radiation for cohorts I-II and III, respectively). Baseline patient, tumor, and treatment characteristics were examined. The primary endpoint was overall survival (OS). Kaplan-Meier analysis, multivariable Cox proportional hazards method, and propensity score matching were used. Results: Among 1,577 patients, cohort I-II had 839 patients (n = 409 with short C, n = 430 with long C) and cohort III had 738 patients (n = 360 with short C, n = 378 with long C). Median follow-up was 39.5 months and 24.3 months for cohorts I-II and III, respectively. The long C group showed improved OS in the multivariable analysis in both cohort I-II (HR 0.72, p < 0.001) and cohort III (HR 0.83, p = 0.025). Using 1:1 propensity score matching, a total of 610 patients for cohort I-II and 542 patients for cohort III were matched. After matching, long C remained statistically significant for improved OS compared with short C in both cohort I-II (median OS 26.1 vs 21.9 months, p = 0.003) and cohort III (median OS 16.7 vs 14.2 months, p = 0.021). Conclusions: Our NCDB study using propensity score matched analysis showed a survival benefit in the use of longer duration chemotherapy compared to shorter duration chemotherapy for both resected stage I-II and unresected stage III pancreatic cancer.

Comparison of concurrent chemoradiation with stereotactic body radiation therapy versus conventionally fractionated radiation therapy following induction chemotherapy for unresected locally advanced pancreatic cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 378-378 ◽  
Author(s):  
Sung Jun Ma ◽  
Austin J Iovoli ◽  
Kavitha M Prezzano ◽  
Gregory Hermann ◽  
Lucas M Serra ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Concurrent Chemoradiation ◽  
Fractionated Radiation Therapy ◽  
Fractionated Radiation ◽  
Conventionally Fractionated

378 Background: Induction chemotherapy (iC) followed by concurrent chemoradiation has been shown to improve overall survival (OS) for locally advanced pancreatic cancer (LAPC). A recent National Cancer Data Base (NCDB) analysis has also shown improved OS with the use of stereotactic body radiation therapy (SBRT) versus conventionally fractionated radiation therapy (CFRT). This NCDB analysis evaluated outcomes of concurrent chemoradiation with SBRT compared to CFRT, following iC. Methods: The NCDB was queried for primary stage III, cT4N0-1M0 unresected pancreatic adenocarcinoma treated with concurrent chemoradiation following iC (2004-2015). CFRT was defined as 1.8-2.5 Gy per fraction up to a total dose of 45-70 Gy, whereas SBRT was defined as > 4.0 Gy per fraction up to a total dose of 20-60 Gy. Baseline patient, tumor, and treatment characteristics were examined. The primary endpoint was overall survival (OS). Kaplan-Meier analysis, Cox proportional hazards method, logistic regression, and propensity score matching were used. Results: Among 872 patients, 738 patients underwent CFRT and 134 patients received SBRT. Median follow-up was 24.3 months and 22.9 months for the CFRT and SBRT cohorts, respectively. The use of SBRT showed improved survival in the multivariable analysis compared to CFRT (HR 0.78, p = 0.025). Using 1:1 propensity score matching, a total of 240 patients were matched, with 120 patients in each cohort. The receipt of SBRT remained statistically significant for improved OS, including median OS (18.1 months vs 15.9 months) and 2-year OS (37.3% vs 25.5%) compared to the CFRT (p = 0.0040). Conclusions: This NCDB analysis shows a significant survival benefit with the use of SBRT versus CFRT, in the setting of definitive management for LAPC following iC. Further prospective studies evaluating the use of SBRT in the definitive treatment of this challenging population are warranted.

Long-Term Survival Outcomes of Cancer-Directed Surgery for Malignant Pleural Mesothelioma: Propensity Score Matching Analysis

2017 ◽  
Vol 35 (29) ◽  
pp. 3354-3362 ◽  
Author(s):  
David B. Nelson ◽  
David C. Rice ◽  
Jiangong Niu ◽  
Scott Atay ◽  
Ara A. Vaporciyan ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Median Survival ◽  
Malignant Pleural Mesothelioma ◽  
Hazard Ratio ◽  
Multimodality Therapy ◽  
Pleural Mesothelioma ◽  
National Cancer Database ◽  
Trimodality Therapy

Purpose Small observational studies have shown a survival advantage to undergoing cancer-directed surgery for malignant pleural mesothelioma (MPM); however, it is unclear if these results are generalizable. Our purpose was to evaluate survival after treatment of MPM with cancer-directed surgery and to explore the effect surgery interaction with chemotherapy or radiation therapy on survival by using the National Cancer Database. Patients and Methods Patients with microscopically proven MPM were identified within the National Cancer Database (2004 to 2014). Propensity score matching was performed 1:2 and among this cohort, a Cox proportional hazards regression model was used to identify predictors of survival. Median survival was calculated by using the Kaplan-Meier method. Results Of 20,561 patients with MPM, 6,645 were identified in the matched cohort, among whom 2,166 underwent no therapy, 2,015 underwent chemotherapy alone, 850 underwent cancer-directed surgery alone, 988 underwent surgery with chemotherapy, and 274 underwent trimodality therapy. The remaining 352 patients underwent another combination of surgery, radiation, or chemotherapy. Thirty-day and 90-day mortality rates were 6.3% and 15.5%. Cancer-directed surgery, chemotherapy, and radiation therapy were independently associated with improved survival (hazard ratio, 0.77, 0.74, and 0.88, respectively). Stratified analysis revealed that surgery-based multimodality therapy demonstrated an improved survival compared with surgery alone, with no significant difference between surgery-based multimodality therapies; however, the largest estimated effect was when cancer-directed surgery, chemotherapy, and radiation therapy were combined (hazard ratio, 0.52). For patients with the epithelial subtype who underwent trimodality therapy, median survival was extended from 14.5 months to 23.4 months. Conclusion MPM is an aggressive and rapidly fatal disease. Surgery-based multimodality therapy was associated with improved survival and may offer therapeutic benefit among carefully selected patients.

scholarly journals Association Between Cardiac Enzyme Elevation and Clinical Prognosis of Neurosurgical and Neurocritically Ill Patients

2021 ◽  
Author(s):  
Jung Hwa Lee ◽  
Yun Im Lee ◽  
Joonghyun Ahn ◽  
Jeong-Am Ryu
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Multivariable Analysis ◽  
Tertiary Hospital ◽  
Secondary Outcome ◽  
Rank Test ◽  
Cardiac Events ◽  
Clinical Prognosis ◽  
Neurosurgical Patients

Abstract Background: To investigate whether cardiac troponin (cTn) elevation is associated with in-hospital mortality and major adverse cardiac events (MACEs) in neurosurgical and neurocritically ill patients. Methods: Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, those whose serum cTnI levels were obtained within 7 days after ICU admission were included. Propensity score matching was used. Each patient with cTnI elevation was matched to one of control patients. The primary endpoint was in-hospital mortality and the secondary outcome was MACE. Results: cTnI elevation was shown in 702 (11.7%) of 6,004 patients. After propensity score matching, 617 pairs of data were generated by 1:1 individual matching without replacement. Rates of in-hospital mortality in the overall population and the propensity score-matched population were higher for patients with cTnI elevation than for those without cTnI elevation (p < 0.001 and p = 0.003, respectively). In addition, MACEs were more common in patients with cTnI elevation than in those without cTnI elevation in the overall population and the propensity score-matched population (both p < 0.001). In multivariable analysis of overall and propensity score-matched population, cTnI elevation were associated with in-hospital mortality (adjusted odds ratio [OR]: 2.78, 95% confidence interval [CI]: 1.95 – 3.95 and adjusted OR: 1.77, 95% CI: 1.20 – 2.62, respectively). In addition, cTnI elevation were associated with MACE (adjusted OR: 3.75, 95% CI: 2.43 – 5.78 and adjusted OR: 4.04, 95% CI: 2.24 – 7.29, respectively). In survival analysis, the mortality rate of patients with cTnI elevation was significantly higher than in those without cTnI elevation for the propensity score-matched population (28.8% vs. 19.3%, log-rank test, p < 0.001).Conclusions: In this study, cTnI elevation was associated with in-hospital mortality and MACEs in neurosurgical and neurocritically ill patients.

Prognostic stratification of pathological node-negative lung adenocarcinoma by carcinoembryonic antigen level

2020 ◽  
Vol 30 (6) ◽  
pp. 820-826
Author(s):  
Khashchuluun Batmunkh ◽  
Sukki Cho ◽  
Sungwon Yum ◽  
Kwhanmien Kim ◽  
Sanghoon Jheon
Keyword(s):  
Propensity Score ◽  
Lung Adenocarcinoma ◽  
Carcinoembryonic Antigen ◽  
Propensity Score Matching ◽  
Multivariable Analysis ◽  
Standardized Uptake Value ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Node Negative ◽  
Significant Difference

Abstract OBJECTIVES Carcinoembryonic antigen (CEA) is a well-known tumour marker for lung adenocarcinoma (AC). This study was conducted to evaluate the clinical characteristics and prognosis of patients with pathological node-negative lung AC who have a high preoperative level of CEA. METHODS Among 2124 patients with lung AC between 2003 and 2016, 858 patients were enrolled. CEA levels were dichotomized as normal (≤5 ng/ml) or high (&gt;5 ng/ml). According to the levels of CEA between 6 and 12 months after surgery, patients were divided into a normalized and a remained-high group. Propensity score matching was used to compare 80 patients without adjuvant chemotherapy (ACT) with 39 patients with ACT. Kaplan–Meier survival analysis with the log-rank test and Cox proportional hazards regression analysis were performed for recurrence-free survival (RFS) and overall survival (OS). RESULTS The multivariable analysis showed that high maximum standardized uptake value and T2 stage were more common in patients with high levels of CEA. The median follow-up period was 52.8 months (range 6–169 months). The 5-year RFS and OS rates were 89.3% and 68.9% and 92.8% and 77.2% in normal patients and patients with high levels of CEA, respectively, with a statistically significant difference. The 5-year RFS was 79.4% and 39.2% in the normalized and remained-high groups after surgery, respectively (P = 0.011). The 5-year RFS and OS rates were 68.9% and 62.2% and 80.1% and 82.9% in patients without and with ACT, respectively. After propensity score matching, RFS was not significantly different between patients without and with ACT (P = 0.500); however, OS was significantly better in patients with ACT than in those without ACT (P = 0.001). CONCLUSIONS The clinicopathological characteristics, RFS and OS of patients with lung AC might be well discriminated by preoperative CEA levels. In patients with node-negative disease and high CEA levels, those with normalized CEA levels had a significantly better prognosis than those with persistently high CEA levels.

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