Intracranial Hemangiopericytoma and the Role of Radiation Therapy A Population Based Analysis

Neurosurgery ◽  
2012 ◽  
Vol 72 (2) ◽  
pp. 203-209 ◽  
Author(s):  
Amol J. Ghia ◽  
Pamela K. Allen ◽  
Anita Mahajan ◽  
Marta Penas-Prado ◽  
Ian E. McCutcheon ◽  
...  
Keyword(s):  
Median Overall Survival ◽  
External Beam Radiotherapy ◽  
Univariate Analysis ◽  
Population Based ◽  
Total Resection ◽  
Entire Cohort ◽  
The Us ◽  
Rare Malignancy ◽  
Cause Specific Survival

Abstract BACKGROUND: Intracranial hemangiopericytoma (HPC) is a rare malignancy for which treatment recommendations vary. OBJECTIVE: We sought to characterize outcomes of HPC patients treated with postoperative external beam radiotherapy (PORT). METHODS: A retrospective analysis was conducted using the Surveillance, Epidemiology and End Results (SEER) Program of the US National Cancer Institute. We identified patients with intracranial hemangiopericytoma who underwent surgery alone or PORT. RESULTS: We identified 88 patients with a diagnosis of HPC between 1982 and 2009 treated with surgery alone or PORT. The majority of patients were female (53%) and white (84%) with a median age of 50.5 years (range, 0–92 years). Gross total resection (GTR) was achieved in 55%, and PORT was delivered to 48% of the entire cohort. The median overall survival (OS) and cause-specific survival (CSS) were 111 months and 161 months, respectively. On univariate analysis, age older than 50 years correlated with poor OS (hazard ratio [HR]: 3.43; 95% confidence interval [CI]: 1.70-6.95; P = .001) and CSS (HR: 2.77; 95% CI: 1.18-6.48; P = .019). On multivariate analysis (MVA), age >50 years correlated with poor OS (HR: 3.69; 95% CI: 1.72-7.93; P = .001) and CSS (HR: 2.67; 95% CI: 1.08-6.59; P = .034). On MVA, GTR correlated with improved OS (HR: 0.28; 95% CI: 0.11-0.71; P = .007) and CSS (HR: 0.23; 95% CI: 0.07-0.76; P = .016). In addition, PORT correlated with improved OS (MVA HR: 0.02; 95% CI: 0.00-0.31; P = .005) and CSS (MVA HR: 0.02; 95% CI: 0.00-0.45; P = .015). Patients undergoing STR with PORT compared favorably with those undergoing GTR alone with respect to OS (HR: 0.43; 95% CI: 0.15-1.26; P = .13) and CSS (HR: 0.51; 95% CI: 0.15-1.78; P = .29). CONCLUSION: In intracranial HPC, both PORT and GTR independently correlate with improved OS and CSS.

The Impact of In-group Favoritism on Trade Preferences

2017 ◽  
Vol 71 (4) ◽  
pp. 827-850 ◽  
Author(s):  
Diana C. Mutz ◽  
Eunji Kim
Keyword(s):  
Well Being ◽  
Population Based ◽  
Trading Partner ◽  
Relative Advantage ◽  
Trade Policies ◽  
Partner Country ◽  
The Us ◽  
Trade Preferences ◽  
The Impact

AbstractUsing a population-based survey experiment, this study evaluates the role of in-group favoritism in influencing American attitudes toward international trade. By systematically altering which countries gain or lose from a given trade policy (Americans and/or people in trading partner countries), we vary the role that in-group favoritism should play in influencing preferences.Our results provide evidence of two distinct forms of in-group favoritism. The first, and least surprising, is that Americans value the well-being of other Americans more than that of people outside their own country. Rather than maximize total gains, Americans choose policies that maximize in-group well-being. This tendency is exacerbated by a sense of national superiority; Americans favor their national in-group to a greater extent if they perceive Americans to be more deserving.Second, high levels of perceived intergroup competition lead some Americans to prefer trade policies that benefit the in-group and hurt the out-group over policies that help both their own country and the trading partner country. For a policy to elicit support, it is important not only that the US benefits, but also that the trading partner country loses so that the US achieves a greater relative advantage. We discuss the implications of these findings for understanding bipartisan public opposition to trade.

Comprehensive Assessment of Clinical Outcomes for CLL Patients with Trisomy 12 (+12): Results of a Population-Based Analysis of 822 CLL Patients in British Columbia (BC), Canada

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3897-3897
Author(s):  
Alina S. Gerrie ◽  
Steven J.T. Huang ◽  
Helene Bruyere ◽  
Chinmay B. Dalal ◽  
Monica Anne Hrynchak ◽  
...  
Keyword(s):  
Protective Effect ◽  
Clinical Outcomes ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Population Level ◽  
Population Based ◽  
Exact Test ◽  
Entire Cohort ◽  
Notch1 Mutations

Abstract Abstract 3897 Background: Important advances in the understanding of CLL pathogenesis include the discovery that NOTCH1 mutations are present in ∼28% of pts harboring +12. There is a need for improved understanding of the clinical outcomes of CLL patients (pts) with +12 on a population-level, as this subgroup is rapidly becoming the focus of biologic studies evaluating pathogenesis of disease and clinical trials investigating novel targeted therapies. In the province of BC, population 4.5 million, CLL pts receive uniform evaluation and therapy based on centrally derived protocols with FISH testing implemented since 2004. We sought to characterize the clinical outcomes of +12 in this large unselected population-based cohort of CLL pts. Methods: Clinical and laboratory data on all pts referred for CLL FISH testing at 1 of 3 BC cytogenetic labs from 2004–2011 were entered into the BC Provincial CLL Database and included in this analysis. Pts without a confirmed diagnostic date were excluded. Baseline features of pts with and without +12 were compared using Fisher's exact test for categorical and Wilcoxon rank sum test for continuous (cnts) variables. Primary and secondary endpoints were OS and TFS (defined as time from diagnosis [dx] to first therapy). Percent of abnormal (%abn) nuclei harboring +12 was evaluated for association with OS/TFS. Cox proportional hazard (PH) models were constructed to determine predictors of OS/TFS for the +12 cohort, including age at dx, sex, Rai stage (0, 1–2, 3–4), WBC at dx, CD38 positivity and concomitant 17p-, 11q- or deletion 13q (13q-). Cox PH models were also constructed to determine effect of +12 on TFS/OS for the entire cohort. Results: As of Dec. 2011, 882 pts had CLL FISH testing in BC of which 164 (19%) had +12 on their 1st FISH test: 8 (5%) with concomitant 17p-; 14 (9%) with 11q-; 142 (86%) without either 17p- or 11q-, of which 43 (30%) had 13q-; 16/124 tested (13%) had an IGH translocation [t(IGH)]. Of the 164 +12 pts, median age at dx was 60 yrs (range 35–93), 70% were male, 10% had Rai stage 3–4. At median follow-up of 4.5 yrs (range 0–19), 95 pts (59%) received treatment, 31 (19%) died. For the +12 cohort, median OS was 14.7 yrs (95% CI 9.8–19.0) and median TFS 3.7 yrs (95% CI 2.7–5.4). Of the 658 non +12 CLL pts (N12CPs), prevalence of recurrent cytogenetic abnormalities (RCA) were: 17p-, 10%; 11q-, 11%; 13q-, 60%; t(IGH) 7%. Significant differences between +12 and N12CPs included more CD38+ pts (66% vs 28%, P<0.001), higher t(IGH) incidence (13% vs 7%, P=0.04) and fewer 17p- (5% vs 10%, P=0.03) or 13q- (26% vs 60%, P<0.001) abn among +12 pts. When pts were grouped by hierarchical FISH abn, +12 pts retained an intermediate OS (median 15.9 yrs) and TFS (median 4.2 yrs) when compared to other RCAs (Fig 1A). Multivariate analysis (MVA) for the whole cohort (n=822) demonstrated no significant effect of +12 on OS (HR 0.72, 95% CI 0.36–1.43, P=.35) or TFS (HR 0.86, 95% CI 0.69–1.36, P=.86) after adjustment for covariates. For the +12 cohort (n=162), univariate analysis demonstrated shorter OS associated with age (P=.001), Rai stage (P=.01) and 17p- (P=.07). A longer OS was associated with presence of 13q- (median OS 11.6 vs 18.7 yrs, P=.04), Fig 1B. Shorter TFS was associated with Rai stage (P<.001), WBC at dx (P=.01) and 17p- (P=.04). %abn nuclei harboring +12 was not predictive of OS (P=.33) or TFS (P=.25) as a cnts variable; however those with <20% vs ≥20% abn had a significant improvement in OS (P=.02). MVA for the +12 cohort demonstrated Rai stage (HR 3.26, 95% CI 1.23– 8.63, P=.02) and 11q- (HR 9.07, 95% CI 1.44–57.02, P=.02) as independent risk factors for OS, while 13q- did not retain its protective effect (P=.98). For TFS, MVA found Rai stage (HR 2.92, 95% CI 1.78–4.78, P<.001) and 17p- (HR 5.44, 95% CI 1.52–19.43, P=.01) as negative predictors while 13q- (HR 2.01, 95% CI 1.08–3.75, P=.03) again had a positive effect. Conclusion: We report the largest, population-based cohort of CLL pts with FISH testing and confirm that +12 occurs in 19% of CLL pts and in the absence of 17p- or 11q-, confers an intermediate prognosis. The presence of 13q- had a protective effect on TFS and a trend towards improved OS, thus improving the prognosis of a subset of +12 pts. This finding is consistent with recent observations that NOTCH1 mutations and 13q- are mutually exclusive in +12 pts and may explain the clinical heterogeneity seen in this subgroup. Further research into these distinct subsets of +12 pts is warranted. Disclosures: No relevant conflicts of interest to declare.

Utilization of radiation therapy in early-stage Hodgkin disease and its impact on survival

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 8511-8511
Author(s):  
J. Rineer ◽  
D. Schreiber ◽  
A. Wortham ◽  
M. Olsheski ◽  
R. Sroufe ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Early Stage ◽  
Clinical Stage ◽  
Large Population ◽  
Population Based ◽  
Stage I ◽  
Hodgkin Disease ◽  
Entire Cohort ◽  
Treatment Paradigm ◽  
Cause Specific Survival

8511 Background: Despite numerous randomized trials confirming the benefit of consolidation radiation therapy (RT) in the management of early stage Hodgkin disease (HD), utilization of RT in this setting remains variable. We performed a population-based analysis to assess the utilization of RT and its impact on overall and cause specific survival. Methods: The surveillance, epidemiology and end results (SEER) registry was used to identify patients aged 15–75 years diagnosed between 1990–2004 with early stage (stage I-IIA/B) HD, excluding nodular lymphocyte predominant HD. Kaplan-Meier analysis was performed to evaluate the effect of RT on overall survival (OS) and cause-specific survival (CSS). Subgroup survival analyses were also performed by era of treatment (1990–1997 and 1998–2004), sex, and patient age (<30, 30–50, and >50 years). Results: A total of 9729 patients met inclusion criteria. Median age of all patients was 34 years. The majority (71.3%) had nodular sclerosis (NS) type HD. By clinical stage, 3399 (34.9%) were stage I, and 6330 (65.1%) were stage II. 5352 patients (55%) received RT. RT was more likely to be employed during the early era of treatment, in younger patients, females, non-Blacks, and in NS, mixed cellularity and lymphocyte-rich HD. For the entire cohort, RT was associated with a significant (p<0.001) improvement in OS and CSS (hazard ratio of 0.537 and 0.437, respectively). The benefit of RT for OS and CSS remained significant for all subgroups analyzed including the era of treatment, sex, and age (p≤0.001). Conclusions: In this large population-based series of early stage HD patients, the use of RT is associated with a significant OS and CSS benefit across all subgroups. Current efforts in clinical trials have aimed at decreasing the utilization of RT among this patient population. This shift in practice is reflected in the data presented here. The omission of RT from the treatment paradigm, however, appears to be related with diminished survival. No significant financial relationships to disclose.

scholarly journals Differentiated Thyroid Cancer with Extrathyroidal Extension: Prognosis and the Role of External Beam Radiotherapy

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Michael A. Sia ◽  
Richard W. Tsang ◽  
Tony Panzarella ◽  
James D. Brierley
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Residual Disease ◽  
External Beam Radiotherapy ◽  
Local Relapse ◽  
Extrathyroidal Extension ◽  
External Beam ◽  
Locoregional Failure ◽  
Cause Specific Survival

A study was performed to identify variables that affected cause-specific survival (CSS) and local relapse-free rate (LRFR) in patients with differentiated thyroid cancer (DTC) and extrathyroid extension (ETE) and to examine the role of external beam radiotherapy (XRT). Prognostic factors were similar to those found in studies of all patients with DTC. In patients with postoperative gross residual disease treated with radiotherapy, 10-year CSS and LRFR were 48% and 90%. For patients with no residual or microscopic disease, 10-year CSS and LRFR were 92% and 93%. In patients older than 60 years with T3 ETE but no gross residual disease postoperatively there was an improved LRFR at 5 years of 96%, compared to 87.5% without XRT (P=.02). Patients with gross ETE benefit from XRT and there may be a potential benefit in reducing locoregional failure in patients over 60 years with minimal extrathyroidal extension (T3).

scholarly journals Largely varying patterns and trends of primary cancer-directed resection for gastric carcinoma with synchronous distant metastasis in Europe and the US: a population-based study calling for further standardization of care

2021 ◽  
Vol 13 ◽  
pp. 175883592110278
Author(s):  
Lei Huang ◽  
Lina Jansen ◽  
Rob H.A. Verhoeven ◽  
Jelle P. Ruurda ◽  
Liesbet Van Eycken ◽  
...  
Keyword(s):  
Gastric Carcinoma ◽  
Distant Metastasis ◽  
Associated Factors ◽  
Large Population ◽  
Population Based ◽  
Primary Cancer ◽  
Association Patterns ◽  
Adjacent Structures ◽  
The Us

Aims: The role of resection remains debated in cases of metastatic gastric carcinoma (mGC). Some mGCs are technically resectable. At the population level, the real-world application of resection for mGC remains largely unclear in most Western countries. This large, population-based international investigation aimed to reveal the resection patterns and trends for mGC and the treatment-associated factors in Europe and the US. Methods: Data on cases with microscopically-confirmed primary invasive stomach carcinoma with distant metastasis were obtained from the nationwide cancer registries of the Netherlands, Belgium, Norway, Sweden, Estonia, and Slovenia and the US Surveillance, Epidemiology, and End Results-18 database. We calculated age-standardized rates of primary cancer-directed resection and assessed resection trends using linear regression. We investigated associations of treatment with patient and cancer factors using multivariable-adjusted log-binomial regression. Results: Among 133,321 patients with gastric cancer, overall, 40,215 cases with mGC diagnosed between 2003–2017 were investigated. Age-standardized resection rates significantly declined over time in the US, Belgium, Sweden, and Norway (by 5–14%). Resection rates greatly differed from 5% to 16% in 2013–2014. Cases with older ages, cardia tumors, or tumors involving adjacent structures were significantly less often operated across most countries. Sex was not significantly associated with resection. Across countries the association patterns and strengths differed largely. With multivariable adjustment, resection rates decreased significantly in all countries except Slovenia and Estonia (prevalence ratio per year = 0.90–0.98), and the decreasing trends were consistently observed in various stratifications by age and location. Conclusion: In Europe and the US, resection patterns and trends largely varied across countries for mGCs, which were mostly less often resected in the early 21st century. Various resection-associated factors were shown, with greatly varying association patterns and strengths. Our report could aid to identify discrepancies in clinical practice and highlight the great need for further clarifying the role of resection in mGCs to enhance standardization of care.

Multiple Myeloma in Manitoba: A Population Based Study.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3326-3326
Author(s):  
David Szwajcer ◽  
Mathew D. Seftel ◽  
Erin Dupont ◽  
Morel Rubinger ◽  
Brent A. Schacter
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Median Overall Survival ◽  
Disease Status ◽  
Population Based ◽  
Hazard Ratio ◽  
High Dose ◽  
Entire Cohort

Abstract Background: We reviewed outcomes for all Manitoba myeloma patients 1993–2006 treated conventionally or with high dose therapy followed by stem cell transplantation. Methods: A retrospective cohort study was undertaken where all individuals with a diagnosis of MM (ICD-O-3) were identified within the CancerCare Manitoba (CCMB) Registry and the Manitoba Blood and Bone Marrow Transplant (MBMT) Registry. Complete incidence, mortality and demographic data are available for all patients in the CCMB registry and complete staging, transplant characteristics and outcome data are available for individuals in the MBMT registry. A multivariate model was used to explore predictors of outcome for the entire cohort. Kaplan-Meier survival analysis was performed to compare those who have and who have not undergone transplantation, as well as to compare those who have undergone autologous (autoSCT) versus allogeneic stem cell transplantation (alloSCT). Results: 771 pts were diagnosed with MM. Incidence rates of MM over the last decade have remained stable. Age and sex adjusted rates (per 105) were 6.6 and 4.5 for males and females respectively. Median age of the cohort was 69, whereas the median age of those who have undergone transplantation is 54. 78 pts underwent autoSCT and 11 underwent alloSCT, with the majority of transplants performed after 2001. As a fraction of total transplants performed per year, MM transplant rates have remained stable since 2002 at 29%. Six pts have undergone sequential transplants for relapse or progression. Median overall survival for those undergoing transplantation is 5.2 years compared to 3 years for those not transplanted (p<0.01). On multivariate analysis, for the entire cohort, undergoing transplantation was associated with a hazard ratio for death of 0.39 (CI 0.25–0.6), while being 70 or above was associated with a hazard ratio for death of 1.45 (CI 1.12–1.87). For those who have undergone transplantation median overall survival was not affected by transplant type, age at transplant (< or ≥ 60), or disease status prior to transplantation (log-rank test p>0.05). Conclusions: In this population based analysis, utilization of stem cell transplantation provides a survival benefit to patients with MM. For those eligible for autoSCT, disease status prior to transplantation does not affect outcome.

Prognostic Relevance of Retrospective WHO Re-Classification in 650 MDS Patients Diagnosed by FAB Criteria

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5097-5097
Author(s):  
Massimo Breccia ◽  
Roberto Latagliata ◽  
Laura Cannella ◽  
Ida Carmosino ◽  
Caterina Stefanizzi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Who Classification ◽  
Median Overall Survival ◽  
Univariate Analysis ◽  
Who Criteria ◽  
Kaplan Meier ◽  
Prognostic Importance ◽  
Disease Subtypes ◽  
Large Groups

Abstract We retrospectively re-classified according to WHO criteria our series of consecutive 650 MDS cases, in order to validate the prognostic role of this classification in a unicentric series of patients. Based on FAB criteria, 196 patients had been diagnosed as RA, 41 as RARS, 242 as RAEB, 74 as RAEB-t and 83 as CMML. The new WHO classification could be applied to 479 of the 650 patients; of 196 FAB-RA only 76 were classified as “pure” RA, with only anemia and erythroid dysplasia, whereas 87 patients were re-evaluated as RCMD, for the presence of peripheral cytopenias and dysplasia in ≥ 10% of 2 cell lines. Twenty-nine patients had cytopenias but with only unilineage dysplasia in granulocytes or megakaryocytes, and were re-interpreted as MDS, unclassified (MDS-U). Of 41 FAB-RARS, 32 maintained their diagnosis, whereas 9 patients were classified as RCMD-RS, based on criteria listed above. One-hundred-one patients were identified as RAEB-1, for the presence of 5–9% blasts in bone marrow, and &lt; 5% peripheral blasts, whereas 141 patients were classified as RAEB-2 for the evidence of 10–19% and of 5–19% blasts in bone marrow and peripheral blood respectively. We tested the WHO classification in univariate analysis with respect to several clinical features at presentation. Significant correlations were found as to hemorrhagic symptoms in RCMD and RAEB-2 patients (p=0.014), acute transformation, with higher frequency in RCMD and RAEB-2 categories (p=0.002), transfusion dependence, with higher requirement in RAEB-2 (107/141 RAEB-2 vs 59/101 RAEB-1) and in RCMD (63/87 patients) categories; also the application of different scoring prognostic systems, such as the Bournemouth and Spanish, appeared to possess stastical significance (p=0.001 and p=0.002, respectively). No differences were found as to sex, age, infection occurrence and cytogenetic abnormalities among various subgroups. Kaplan-Meier survival test showed high significance, with median overall survival ranging from 55.8 months for pure RA to 22.6 months for RAEB-2 category (p=0.00001). In conclusion, the retrospective application of WHO classification to our series of MDS patients clearly identified prognostic correlations in various disease subtypes. Categorization of MDS entities according to WHO criteria may distinguish parameters of prognostic importance in large groups of patients with morphological similar features.

scholarly journals Demographics and Survival in Primary Effusion Lymphoma: SEER Database Analysis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5397-5397
Author(s):  
John Khoury ◽  
Christopher Allen Willner ◽  
Bolanle Gbadamosi ◽  
Susanna Gaikazian ◽  
Ishmael Jaiyesimi
Keyword(s):  
Overall Survival ◽  
Survival Data ◽  
Median Overall Survival ◽  
Conflicts Of Interest ◽  
Primary Effusion Lymphoma ◽  
Multivariable Analysis ◽  
Cancer Registries ◽  
Population Based ◽  
Published Data ◽  
Entire Cohort

Abstract Background: Primary effusion lymphoma (PEL) is one of the least common of the AIDS-related lymphomas, accounting for less than 4% of cases. The optimal treatment for primary effusion lymphoma (PEL) remains unclear and there is a paucity of data regarding this neoplasm, which carries a uniformly poor prognosis. Antiretroviral therapy in addition to chemotherapy has shown to improve survival in a few small retrospective studies. Methods: Between 2002 and 2014, all cases of PEL were extracted from the population-based cancer registries of the Surveillance Epidemiology and End Results program (SEER). Instances of PEL were identified with the ICD-O-3 (9678) histological code. Frequency, demographics, and survival data were assessed using SPSS statistical software. Results: A total of 117 cases of PEL were identified. PEL was significantly more prevalent in men (89.7%) and in Caucasians (77.8%) with median age at diagnosis of 49 years. Median overall survival in the entire cohort was 6 months; CI, 3.7 to 8.2 months. Of all PEL cases, 62.4% received chemotherapy and 37.6% did not. Those who received chemotherapy had a median overall survival of 10 months vs less than one month when compared to subjects who did not receive chemotherapy (p = 0.002). PEL was the cause of death in 40.2% of the cases. PEL-specific median overall survival was markedly higher (29.000 months) than that of the entire cohort. Multivariable analysis demonstrated that age and race were not associated with mortality. Chemotherapy was associated with decreased mortality risk (HR, 0.45; CI, 0.28 -0.74; p = 0.002) Conclusions: In confirmation of previously published data, the highest incidence of PEL was found in Caucasian males. Subjects who received chemotherapy were found to have improved overall survival outcome. Other factors not related to PEL were associated with early mortality in this population. Disclosures No relevant conflicts of interest to declare.

scholarly journals Determining the role of adjuvant radiotherapy in the management of meningioma: a Surveillance, Epidemiology, and End Results analysis

2019 ◽  
Vol 46 (6) ◽  
pp. E3 ◽  
Author(s):  
Abhinav K. Reddy ◽  
James S. Ryoo ◽  
Steven Denyer ◽  
Laura S. McGuire ◽  
Ankit I. Mehta
Keyword(s):  
Adjuvant Radiotherapy ◽  
Survival Benefit ◽  
Atypical Meningioma ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Adjuvant Radiation ◽  
Total Resection ◽  
Cause Specific Survival ◽  
End Results

OBJECTIVEThe aim of this study was to illustrate the demographic characteristics of meningioma patients and observe the effect of adjuvant radiation therapy on survival by using the Surveillance, Epidemiology, and End Results (SEER) database. More specifically, the authors aimed to answer the question of whether adjuvant radiotherapy following resection of atypical meningioma confers a cause-specific survival benefit. Additionally, they attempted to add to previous characterizations of the epidemiology of primary meningiomas and assess the effectiveness of the standard of care for benign and anaplastic meningiomas. They also sought to characterize the efficacy of various treatment options in atypical and anaplastic meningiomas separately since nearly all other analyses have grouped these two together despite varying treatment regimens for these behavior categories.METHODSSEER data from 1973 to 2015 were queried using appropriate ICD-O-3 codes for benign, atypical, and anaplastic meningiomas. Patient demographics, tumor characteristics, and treatment choices were analyzed. The effects of treatment were examined using a multivariate Cox proportional hazards model and Kaplan-Meier survival analysis.RESULTSA total of 57,998 patients were included in the analysis of demographic, meningioma, and treatment characteristics. Among this population, cases of unspecified WHO tumor grade were excluded in the multivariate analysis, leaving a total of 12,931 patients to examine outcomes among treatment paradigms. In benign meningiomas, gross-total resection (HR 0.289, p = 0.013) imparted a significant cause-specific survival benefit over no treatment. In anaplastic meningioma cases, adjuvant radiotherapy imparted a significant survival benefit following both subtotal (HR 0.089, p = 0.018) and gross-total (HR 0.162, p = 0.002) resection as compared to gross-total resection alone. In atypical tumors, gross-total resection plus radiotherapy did not significantly change the hazard risk (HR 1.353, p = 0.628) compared to gross-total resection alone. Similarly, it was found that adjuvant radiation did not significantly benefit survival after a subtotal resection (HR 1.440, p = 0.644).CONCLUSIONSThe results of this study demonstrate that the role of adjuvant radiotherapy, especially after the resection of atypical meningioma, remains somewhat unclear. Thus, given these results, prospective randomized clinical studies are warranted to provide clear information on the effects of adjuvant radiation in meningioma treatment.

Effect of adjuvant (AD) radiotherapy (RT) on outcomes following pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PDA): A margin-stratified analysis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 311-311
Author(s):  
Lee Mayer Ocuin ◽  
Jennifer Lee Miller ◽  
Mazen S Zenati ◽  
Jennifer Steve ◽  
Aatur D. Singhi ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Multivariate Regression Analysis ◽  
Entire Cohort ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Node Ratio ◽  
Definition Of ◽  
Stratified Analysis

311 Background: The role of RT following PD for PDA remains controversial due to ambiguity in the definition of R0/R1 margin status in existing clinical trials. Recent data suggest that increased margin clearance (MC) is associated with improved survival after PD for PDA, however the role of adjuvant radiotherapy (ADRT) in patients with known MC is undefined. We sought to analyze the influence of ADRT on outcomes of PD for PDA based on MC data. Methods: We retrospectively identified 326 patients with MC data (in mm) who underwent PD between 2002-2014. Recurrence-free (RFS) and overall survival (OS) was determined by Kaplan-Meier analysis. Hazard ratios (HR) were calculated by Cox multivariate regression analysis on significant variables. Results: Mean age was 68 yrs and 55% were male. Median follow-up was 21 mos (IQR 12-34 mos). ADRT was administered to 87 patients (27%). Median RFS and OS for the entire cohort was 14 mos and 25 mos. On univariate analysis, ADRT was not associated with improved median RFS (13 vs. 14 mos; p = NS) or OS (23 vs. 27 mos; p = NS), but increasing MC was associated with prolonged median RFS [10 (0mm) vs. 13 (0-1mm) vs. 23 mos ( > 1mm); p < 0.02 for all pairs] and OS [16 (0mm) vs. 23 (0-1mm) vs. 40 mos ( > 1mm); p < 0.01 for all pairs]. After controlling for sex, BMI, neoadjuvant therapy, LVI, PNI, lymph node ratio > 0.2, tumor size > 2.5cm, and adjuvant chemotherapy, increasing MC was independently associated with improved OS [HR 0.680; p = 0.034 (0-1mm); HR 0.451; p < 0.001 ( > 1mm), compared to 0mm]. Patients were subsequently stratified into 3 groups based on MC [0mm (n = 73); 0-1mm (n = 118); > 1mm (n = 135)]. ADRT was administered less frequently to patients with greater MC [0mm (n = 29; 41%); 0-1mm (n = 36; 31%); > 1mm (n = 22; 16%); p < 0.001]. Even when stratified by MC, ADRT was not associated with improved RFS [10 vs. 9 mos (0mm); 13 vs. 12 mos (0-1mm); 21 vs. 23 mos ( > 1mm); p = NS for all pairs] or OS [16 vs. 18 mos (0mm); 24 vs. 23 mos (0-1mm); 33 vs. 42 mos ( > 1mm); p = NS for all pairs]. Conclusions: ADRT is not associated with improved RFS or OS following PD for PDA regardless of MC. The use of RT following PD for PDA should be re-examined.

Sign in / Sign up

Export Citation Format

Share Document