Chemoradiation Therapy For Stage Research Articles

A mid-chemoradiation dynamic risk model integrating tumor features and ctDNA analysis for lung cancer outcome prediction.

9046 Background: Circulating tumor DNA (ctDNA) molecular residual disease after curative intent therapy predicts disease progression in localized lung cancer. We hypothesized that integrating pre-CRT features and ctDNA levels during chemoradiation therapy (CRT) can predict patient outcomes earlier to enable response-adapted therapy. Methods: We identified pre-CRT features prognostic of disease progression after CRT for Stage II-III non-small cell lung cancer (NSCLC) in a historical “pre-CRT” training cohort of 109 patients. In addition, we applied CAPP-Seq ctDNA analysis pre-CRT and a median of 21 days into CRT (mid-CRT) to a “ctDNA” training cohort of 42 patients treated at MD Anderson and an independent validation cohort of 21 patients treated at Stanford. Prognostic pre-CRT features and mid-CRT ctDNA concentration were integrated using a Bayesian proportional hazards approach to generate a Continuous Individualized Risk Index (Kurtz et al. Cell 2019) for NSCLC (CIRI-NSCLC) to predict freedom from progression (FFP). Results: Adenocarcinoma histology (HR 2.6, P = 0.0005) and KEAP1 mutation (HR 2.7, P = 0.002) but not stage (P = 0.16), age (P = 0.60), or gender (P = 0.98) were significantly associated with FFP in the pre-CRT training cohort. Mid-CRT ctDNA concentration as a continuous variable was significantly associated with FFP in the ctDNA training cohort (HR 1.6, P = 0.04), and applying an optimal threshold identified in the training cohort (3.2 hGE/ml) significantly stratified FFP in the independent ctDNA validation cohort (HR 4.8, P = 0.02). CIRI-NSCLC enabled individualized real-time updating of the probability of FFP as model features became available over the course of CRT. CIRI-NSCLC outperformed individual model features in the independent validation cohort when compared by C-statistic (CIRI-NSCLC: 0.85; mid-CRT ctDNA: 0.76; histology: 0.66; KEAP1: 0.60). Across the whole cohort, patients with a greater than 66% risk of progression predicted by CIRI-NSCLC (n = 10) had an FFP of 10.0% at 12 months while patients with a less than 33% risk of progression predicted by CIRI-NSCLC (n = 22) had an FFP of 79.7% at 12 months (HR 15.0, P < 0.001). Conclusions: Our results suggest that CIRI-NSCLC can identify patients at very high and low risk of progression. Prospective evaluation will be necessary to test the potential utility of adapting treatment based on CIRI-NSCLC.

ES02.02 Management of EGFR LA Disease

ES02.02 Management of EGFR LA Disease

Neoadjuvant Versus Adjuvant Chemoradiotherapy for Stage II–III Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

Many clinical trials have explored the value of neoadjuvant or adjuvant chemoradiation therapy in stage II–III squamous cell carcinoma (ESCC). However, these studies have produced conflicting results. This retrospective study was performed to investigate whether patients with stage II/III ESCC should receive neoadjuvant or adjuvant therapy in addition to surgery. A total of 206 patients with clinical stage II and III ESCC who underwent esophagectomy and either neoadjuvant or adjuvant chemoradiation were included. On the basis of the sequence of surgery and chemoradiation, the patients were divided into two groups: Neoadjuvant chemoradiation followed by surgery (neoadjuvant CRT group) and surgery followed by postoperative chemoradiation (adjuvant CRT group). Propensity score matching analysis was used to identify 62 well-balanced patients in each group for outcome comparison. In all, 69 and 137 patients were in the neoadjuvant CRT group and adjuvant CRT group, respectively. Before matching, no differences were observed in the overall survival among the patients in these two groups (P = 0.209). After matching, the survival was similar between neoadjuvant CRT group and adjuvant CRT group (P = 0.933). The median survival times and 1, 3, 5-year overall survival (OS) rates for the neoadjuvant and adjuvant CRT groups were 40.4 versus 41.0 months, 83.3% versus 95.1%, 54.6% versus 54.0%, 37.0% versus 30.7%, respectively. In the subgroup analysis, patients with clinical T3/4 stage and N1 stage tumors were more likely to demonstrate an overall survival benefit from neoadjuvant CRT compared with adjuvant CRT. No survival and perioperative complications difference were observed among esophageal cancer patients in the neoadjuvant CRT and adjuvant CRT groups. However, neoadjuvant CRT is recommended for patients with clinical T3/4 stage and N1 stage tumors.

Neoadjuvant versus adjuvant chemoradiotherapy for stage II–III esophageal squamous cell carcinoma: A propensity score-matched analysis.

e15524 Background: Many clinical trials have explored the value of neoadjuvant or adjuvant chemoradiation therapy in stage II–III squamous cell carcinoma (ESCC). However, these studies have produced conflicting results. This retrospective study was performed to investigate whether patients with stage II/III ESCC should receive neoadjuvant or adjuvant therapy in addition to surgery. Methods: A total of 206 patients with clinical stage II and III ESCC who underwent esophagectomy and either neoadjuvant or adjuvant chemoradiation were included. On the basis of the sequence of surgery and chemoradiation, the patients were divided into two groups: Neoadjuvant chemoradiation followed by surgery (neoadjuvant CRT group) and surgery followed by postoperative chemoradiation (adjuvant CRT group). Propensity score matching analysis was used to identify 62 well-balanced patients in each group for outcome comparison. Results: In all, 69 and 137 patients were in the neoadjuvant CRT group and adjuvant CRT group, respectively. Before matching, no differences were observed in the overall survival among the patients in these two groups (P = 0.209). After matching, the survival was similar between neoadjuvant CRT group and adjuvant CRT group (P = 0.933). The median survival times and 1, 3, 5-year overall survival (OS) rates for the neoadjuvant and adjuvant CRT groups were 40.4 versus 41.0 months, 83.3% versus 95.1%, 54.6% versus 54.0%, 37.0% versus 30.7%, respectively. In the subgroup analysis, patients with clinical T3/4 stage and N1 stage tumors were more likely to demonstrate an overall survival benefit from neoadjuvant CRT compared with adjuvant CRT. Conclusions: No survival and perioperative complications difference were observed among esophageal cancer patients in the neoadjuvant CRT and adjuvant CRT groups. However, neoadjuvant CRT is recommended for patients with clinical T3/4 stage and N1 stage tumors.

Factors Predictive of Receiving Chemoradiation Therapy in Stage II and III Rectosigmoid Cancer and the Impact on Overall Survival

The optimal treatment paradigm for rectosigmoid cancers is unknown, and it is debated whether rectosigmoid cancers should be treated as a subset of either colon or rectal cancer. We aimed to investigate the patterns of care and overall survival (OS) benefit for rectosigmoid cancer treated with chemotherapy, radiotherapy, resection, or with a multimodal approach, utilizing a large national registry of patients. Adult patients with stage II or III rectosigmoid cancer diagnosed from 2004 to 2013 were included. Logistic and Cox regression modeling was used to identify factors predictive of receipt of chemoradiation therapy (CRT) and OS. Survival analysis was performed with Kaplan Meier and log rank analysis. Propensity score matching and sensitivity analysis was performed to address selection bias and presence of potential confounding variables. A total of 7,540 patients were identified. 4,226 patients (56%) received surgery with or without chemotherapy (S ± CT), while 3,314 patients (44%) received CRT. Of those patients who received CRT, 2,174 patients received neoadjuvant CRT, 1,128 patients received adjuvant CRT, and 12 patients received both neoadjuvant and adjuvant CRT. Utilization of S ± CT increased over the study period (p = 0.04). Factors predictive of receiving CRT on multivariate analysis included: clinical stage T3 (OR: 3.28, 95% CI 2.12 to 5.09), T4 (OR: 4.67, 95% CI 2.92 to 7.45), positive nodal status of N1 (OR 1.83, 95% CI 1.60 to 2.09) and N2 (OR 1.27, 95% CI 1.04 to 1.55). Compared to S ± CT, CRT was associated with a decreased risk of death on multivariate analysis (HR: 0.68, 95% CI 0.62 to 0.75). Median survival in years for S ± CT and for CRT was 37.49 months and 41.9 months, respectively (p < 0.01). The benefit of CRT over S ± CT persisted after propensity score matching. On subset analysis, neoadjuvant CRT was associated with a decreased risk of death on univariate analysis (HR: 0.66, 95% CI 0.59 to 0.73) but not on multivariate analysis (HR: 0.92, 95% CI 0.81 to 1.09). Adjuvant CRT was associated with a decreased risk of death on multivariate analysis (HR: 0.75, 95% CI 0.64 to 0.88). The use of CRT for stage II and III rectosigmoid cancer is decreasing. Overall, when compared to S ± CT, use of CRT is associated with an OS benefit. However, we found no advantage of neoadjuvant CRT (standard rectal cancer treatment) over S ± CT when controlling for other factors like clinical stage. Adjuvant CRT is beneficial for appropriately selected patients.

A Retrospective Study of Shrinking Field Radiation Therapy During Chemoradiation Therapy in Stage III Non-Small Cell Lung Cancer

A Retrospective Study of Shrinking Field Radiation Therapy During Chemoradiation Therapy in Stage III Non-Small Cell Lung Cancer

Radiation Dose to the Heart and Mortality in Patients Receiving Definitive Chemoradiation Therapy for Stage III Non-Small Cell Lung Cancer

Radiation Dose to the Heart and Mortality in Patients Receiving Definitive Chemoradiation Therapy for Stage III Non-Small Cell Lung Cancer

Outcome of Concurrent Chemoradiation Therapy for Stage III Non-Small Cell Lung Cancer

Outcome of Concurrent Chemoradiation Therapy for Stage III Non-Small Cell Lung Cancer

Concurrent Chemoradiation Therapy for Stage IV Non-Small Cell Lung Cancer: Results of a Prospective, Single-Center Study

Concurrent Chemoradiation Therapy for Stage IV Non-Small Cell Lung Cancer: Results of a Prospective, Single-Center Study

Comparison of radiation therapy alone and concurrent chemoradiation therapy in stage III cervical cancer: A multicenter retrospective study

To evaluate whether concurrent chemoradiation therapy (CRT) improves overall survival as compared to radiation therapy (RT) alone in stage III cervical cancers. A multicenter retrospective review. Nine tertiary medical centers in Korea. A total of 277 patients treated for stage III cervical cancer without para-aortic lymph node (PALN) metastasis based on clinical staging workup from 1996 to 2003. Medical and histopathological record review. Disease-specific overall survival. CRT and RT alone were performed in 172 and 105 patients, respectively. There was no significant difference in disease-specific overall survival between the CRT and RT alone arms based on clinical staging workup, even though the CRT arm was characterized by younger age, more favorable performance status and lower pretreatment blood urea nitrogen level as compared to the RT alone arm. In the CRT arm, three patients succumbed to treatment-related death. CRT does not improve the overall survival rate in stage III cervical cancer as compared to RT alone based on clinical staging workup for PALN status. Special care needs to be taken regarding optimal dose and duration of RT, use of brachytherapy, anemia control and accurate pretreatment staging workup to improve survival outcome in patients with stage III cervical cancer.

The role of surgery after chemoradiation therapy and brachytherapy for stage IB2/II cervical cancer

Objective The aim of this study was to review the results of completion surgery after chemoradiation therapy in stage IB2/II cervical carcinoma. Methods Analysis of series published in the literature about completion surgery in this context. Results Stages of the disease included in those series were stage IB2–IVA disease. The rate of residual disease was correlated with initial stage of the disease and the use of preoperative brachytherapy. Morbidity of such management varied between 15% and 47% and was correlated with the radicality of the surgical procedure and the size of the residual disease. The rate of complete pathological response varied between 52% and 76%. The survival of patients was correlated with the presence and the size of the residual disease and the presence of a nodal involvement. Conclusion Completion surgery after chemoradiation therapy has a place in the multimodality management of stage IB2 or II cervical cancer, particularly in cases of bulky residual disease. Nevertheless further investigations are needed, particularly with collaborative studies, to analyze the real impact of such surgery on the survival of patients.

S023 Deferring Planned Neck Dissection After Chemoradiation Therapy in Stage IV Head and Neck Cancer: The Utility of PET/CT

S023 Deferring Planned Neck Dissection After Chemoradiation Therapy in Stage IV Head and Neck Cancer: The Utility of PET/CT

Concomitant chemoradiation therapy in stage III non small cell cung cancer : P. JUIN, J. F. POLLET, X. MURACCIOLE, J. P. ROCCASERRA, Y. ROUAH, F. RIITANO, P. BERGERON, Marseille. France

Concomitant chemoradiation therapy in stage III non small cell cung cancer : P. JUIN, J. F. POLLET, X. MURACCIOLE, J. P. ROCCASERRA, Y. ROUAH, F. RIITANO, P. BERGERON, Marseille. France