Impact Of Adjuvant Radiotherapy Research Articles

PO-0851: Impact of Adjuvant Radiation Therapy for Advanced Cutaneous Squamous Cell Carcinoma of Head and Neck

PO-0851: Impact of Adjuvant Radiation Therapy for Advanced Cutaneous Squamous Cell Carcinoma of Head and Neck

685 - Impact of adjuvant radiotherapy in patients with high burden lymph node metastases after radical prostatectomy

685 - Impact of adjuvant radiotherapy in patients with high burden lymph node metastases after radical prostatectomy

Indication of adjuvant chemoradiation post neoadjuvant chemotherapy in very locally advanced borderline resectable head and neck cancer.

e18505 Background: Adjuvant chemoradiation (ACRT) is indicated in the presence of margin positivity or extranodal extension. However, indications of ACRT post neoadjuvant chemotherapy (NACT) is not well defined. At our centre, ACRT is administered in the majority of patients who undergo NACT. This analysis was performed to identify indications for the avoidance of ACRT post NACT. Methods: 160 very locally advanced borderline resectable HNSCC who underwent surgery after NACT were selected. The adjuvant treatment administered was either radiation or chemoradiation at the discretion of the joint clinic. The post-surgical tumour and nodal specimen were graded in accordance with modified tumour regression grade (MTRG). Where grade 1 indicated a complete pathological response. The primary endpoint was disease-free survival (DFS). The patients were divided into 3 biological distinct classes. Group-1 had a pathological complete response (CR) in both tumour and nodes, Group-2 had pathological CR in either tumour or nodes and Group 3 had no pathological CR. Kaplan Meier method was used for the estimation of DFS. The stratified (for groups) log-rank test was used for evaluating the impact of adjuvant radiation. Stratified Cox regression analysis was used for the calculation of hazard ratio. A p-value of 0.05 was considered significant. Results: There were 56 patients (35%) in group 3, 75 (46.9%) in group 2 and 29 (18.1%) in group 1. The overall median DFS was 89.067 months (95%CI 15.345-162.788). The 5-year DFS was 22.1% in group 3, 75.4% in group 2 and 92.3% in group 1 ( P-value < 0.0001). Adjuvant radiation was received by all patients and concurrent chemotherapy was received by 134 (83.8%) patients. Use of concurrent chemotherapy decreased the hazard of disease recurrence (HR-0.297 95%CI 0.135-0.656, P-value = 0.003). The stratified log-rank test p-value was 0.002. Conclusions: Adjuvant chemoradiation is needed after neoadjuvant chemotherapy in very locally advanced borderline resectable head and neck cancer

Impact of adjuvant radiotherapy on the survival of women with optimally resected stage III endometrial cancer in the era of modern radiotherapy: a retrospective study

BackgroundThe optimal adjuvant treatment for stage III endometrial cancer in the era of modern radiotherapy remains undefined. We investigated the benefit of adjuvant radiotherapy for women who underwent optimal resection for stage III endometrial cancer in the era of modern radiotherapy.MethodsWe retrospectively reviewed patients with endometrial cancer who were treated between 2010 and 2018. Adjuvant treatment included radiotherapy by modern radiotherapy techniques (intensity-modulated or volumetric modulated arc radiotherapy), chemotherapy, or both. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method and analyzed via multivariate Cox proportional hazards models.ResultsOne hundred sixty-one patients were initially included (52, 9, and 100 with stages IIIA, IIIB, and IIIC cancer, respectively); 154 patients (96%) received adjuvant therapy. Such adjuvant treatment was associated with improved RFS (p = 0.014) and OS (p = 0.044) over surgery alone. Adjuvant radiotherapy by modern radiotherapy techniques led to low incidence of acute (25%) and chronic (7%) grade ≥ 2 gastrointestinal toxicity. On univariate analysis, non-endometrioid histology and grade 3 status were associated with higher risks of tumor recurrence and death, whereas adjuvant radiotherapy alone or in combination chemotherapy reduced their risks. On multivariate analysis, non-endometrioid histology was associated with increased recurrence (hazard ratio [HR], 2.95; p = 0.009), whereas adjuvant radiotherapy alone or with chemotherapy was associated with lower recurrence (HR, 0.62; p = 0.042). Patients > 60 years of age (p = 0.038) as well as those with endometrioid histology (p = 0.045), lymphovascular space invasion (p = 0.031), and ≥ 2 positive lymph nodes (p = 0.044) benefited most from adjuvant radiotherapy.ConclusionsModern adjuvant radiotherapy (intensity-modulated or volumetric modulated arc radiotherapy) alone or with chemotherapy should be considered for women with optimally resected stage III endometrial cancer.Trial registrationClinicalTrials.gov, NCT04251676. Registered 24 January 2020. Retrospectively registered.

Impact of Adjuvant Radiation Therapy in Patients With Male Breast Cancer: A Multicenter International Analysis

PurposeBreast cancer in men accounts for approximately 1% of all breast cancers. Breast cancer trials have routinely excluded men. The aim of this analysis was to determine the effect of different treatment factors, in particular, postoperative radiation therapy (RT) on long-term outcomes. Methods and MaterialsSeventy-one patients with male breast cancer treated in 5 closely cooperating institutions between 2003 and 2019 were analyzed. ResultsAlmost all patients (95%) underwent surgical resection. Forty-two patients (59%) received chemotherapy, and 59 (83%) received adjuvant hormonal therapy. Of the 71 patients, 52 (73%) were treated with RT. The rate of recurrence was 20% in the whole cohort, with a locoregional recurrence rate of 3%. In the entire group, the 5-year local control (LC) was 95%, whereas 5-year progression-free survival (PFS) and 5-year overall survival (OS) were 62% and 96%, respectively. There was a lower rate of relapses after adjuvant RT (19% vs 32%, P = .05) without in-field relapse after postoperative RT (0%) versus 10% in patients without RT (P = .02). In the multivariate analysis performed, hormonal therapy administration was found to have a possible significant effect on LC and PFS. Administration of adjuvant RT and stage affect PFS. In patients who received RT, there were no grade 3 or 4 acute toxicities. ConclusionsAdjuvant RT is an effective and safe treatment for male breast cancer patients with no infield relapses and better PFS. Hormonal therapy administration was found to have a possible effect on LC and PFS.

Intermediate-grade carcinoma of the parotid and the impact of adjuvant radiation.

To determine the influence of adjuvant radiotherapy on survival in surgically-managed early stage intermediate-grade mucoepidermoid and acinic cell carcinoma of the parotid. The National Cancer Database was reviewed between 2004 and 2015 to identify patients with intermediate-grade, early T-stage, node-negative parotid carcinoma who underwent parotidectomy ± radiotherapy. There were 744 patients identified of which 81% had mucoepidermoid carcinoma and 19% had acinic cell carcinoma. Positive surgical margins were identified in 21% and adjuvant radiotherapy was administered in 38% of cases. Of the 159 patients with positive margins, 113 (71%) received adjuvant radiotherapy. Of the 585 patients with negative margins, 173 (30%) underwent adjuvant radiotherapy. In multivariable analysis, age (over 52 years: HR 5.19, 95%CI 2.33-11.57), insurance status (private insurance: HR 0.24 95%CI 0.13-0.43), and extent of parotidectomy (total parotidectomy: HR 2.02 95%CI 1.23-3.31) were significantly associated with overall survival, while adjuvant radiotherapy was not a significant predictive factor (HR 0.81, 95%CI 0.49-1.36). In patients with positive margin resections, however, adjuvant radiation was an independent predictor of improved survival when adjusted for age, insurance status, and extent of parotidectomy (HR 0.34, 95%CI 0.13-0.88). Conversely, in patients with negative margin resections, adjuvant radiation did not influence survival outcomes when adjusted for these covariates (HR 1.02, 95%CI 0.53-1.93). In patients with early stage intermediate-grade parotid carcinoma, adjuvant radiotherapy significantly and independently improves survival in those with post-operative positive margins. Adjuvant therapy, however, does not appear to improve survival outcomes in those with negative margin resections.

Impact of Adjuvant Radiotherapy on Survival of Patients with Pathological High-Risk Muscle Invasive Bladder Cancer: A Propensity Scored Match Paired Analysis

Radical cystectomy (RC) and pelvic lymph-node dissection (LND) is standard treatment for non-metastatic muscle-invasive urothelial bladder cancer (MIBC). However, loco-regional recurrence (LRR) is a common early event associated with poor prognosis. We tested the hypothesis that the impact of adjuvant radiotherapy (aRT) on oncological outcomes in these individuals is related to tumor characteristics. We retrospectively evaluated 490 patients with muscle invasive bladder cancer (MIBC) with a pT3-4 and/or N+ and/or positive surgical margins (PSM) disease treated with RC with or without aRT between 2000 and 2013 at five tertiary care centers. A 1:1 propensity score matched cohort was built to adjust for age, gender, and neoadjuvant chemotherapy. Multivariable Cox regression analyses on the matched cohort tested the relationship between aRT and LRR, cancer specific mortality (CSM) and overall mortality (OM). 5 years-recurrence-free survival risk stratification-tree analysis was built on the whole matched cohort. Acute Gastro-Intestinal (GI), Genito-Urinary and Blood Count Disorders (BCD) toxicities were recorded according to CTCAE V4.0 scale. Median follow-up was 25 months (Interquartile range: 11-55). Overall, 16% of patients received aRT. At multivariable analysis, aRT was associated with more favorable RR rate (hazard ratio [HR] 0.49, 95% Confidence Interval [CI]: 0.24-0.99), p=0.04). When patients were stratified into risk groups, only those with PSM benefited from aRT. These results were confirmed when 5-years recurrence-free survival was examined as an end point. Moreover, 5 % and 4 % of patients presented grade > 2 acute GI or GU toxicities, respectively. Because of poor prognosis, an effective post-operative standard of care is needed for pathological high-risk MIBC. aRT seems feasible and may have oncological benefits. Prospective trials evaluating this approach with current RT techniques should be undertaken.

Early oral cavity cancer: The prognostic factors and impact of adjuvant radiation on survival.

Early oral cavity cancer has good prognosis but recurrence in them is still not uncommon. There is no general consensus on the prognostic factors and adjuvant therapy that would have a significant impact on survival. A retrospective analysis of early oral cavity cancer patients during the time period 2009-2017. The data regarding demographics, histopathological features, and recurrence patterns were collected and analyzed. Depth of invasion (DOI) was the most important prognostic factor among all the factors analyzed. Further analysis showed that addition of adjuvant radiotherapy for patients with DOI >5 mm did not show survival benefits (P = .73). Another subset analysis of patients with DOI >10 mm also did not show any survival advantage with adjuvant therapy P = .24. There is no benefit of adding adjuvant RT in patients with DOI > 5 mm or in patients who were upstaged to T3 based only on DOI.

Prognostic differences and the effect of radiotherapy on survival in Merkel cell carcinoma: A retrospective analysis of a Swedish cohort.

e21047 Background: Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine skin cancer. The pathogenesis is linked to the immune system and Merkel cell polyoma virus (MCPyV) is present in about 80% of MCC. Reports have shown that patients with a virus-negative MCC have a worse prognosis. Adjuvant radiotherapy given after surgery has previously been shown to give a survival benefit in retrospective data. Our aim is to analyze clinical variables and their prognostic impact in a Swedish cohort. Methods: All patients with confirmed diagnosis of MCC referred to Karolinska University Hospital in Sweden from 1989-2018 were included and retrospective data was collected. Results: 113 patients were included. Median age at operation was 75.4 years (range 19-99); 64 (57%) were female. Treatment included surgery with (n = 46) or without adjuvant radiotherapy (RT). 43% of female patients and 37% of male patients received RT. Median overall survival (OS) was 2,6 years (range 0,1-25,8), for female patients 3,4 years (range 0,1-25,8) and for male patients 1,8 years (range 0,1-19,0). Median OS in surgery group was 1,8 years (range 0,4-25,8). With adjuvant RT median OS improved with 1,7 years (p = 0,0001) to 3,5 years (range 0,2-22,1), for female patients 4,0 years (range 0,2-22,1) and for male patients 2,0 years (range 0,3-8,8). MCPyV status was available in 53 patients. 74% were MCPyV positive, 26% negative. MCPyV gave no difference in OS, however when gender was added in to multivariate analysis, female patients with virus negative disease had better outcome than virus negative males (p = 0.03). In virus positive MCC there was no difference in OS between female and male patients. Conclusions: Our data confirms the positive impact of adjuvant radiotherapy on survival and illustrates the difference in outcome between female and male patients, with women having a better outcome. In the MCPyV group the tendency is that men with virus negative MCC has the worst outcome. Our findings indicate that MCPyV positive and negative MCC act as two different diseases and it also raises questions if there is a difference in the disease itself or the immune response towards MCC between male and female patients.

Retrospective study on the benefit of adjuvant radiotherapy in men with intraductal carcinoma of prostate

BackgroundIntraductal carcinoma of the prostate (IDC-P) is an independent biomarker of recurrence and survival with particular treatment response, yet no study has tested its response to radiotherapy. The aim of our project was to test the impact of adjuvant radiotherapy (ART) in patients with localized to locally advanced prostate cancer (PC) and IDC-P.Materials and methodsWe performed a retrospective study of men with pT2-T3 PC treated by radical prostatectomy (RP) with or without ART, from two centres (1993–2015). Exclusion criteria were the use of another type of treatment prior to biochemical recurrence (BCR), and detectable prostate- specific antigen (PSA) following RP or ART. Primary outcome was BCR (2 consecutive PSA ≥ 0.2 ng/ml). Patients were grouped by treatment (RPonly/RP + ART), IDC-P status, and presence of high-risk features (HRF: Grade Groups 4–5, positive margins, pT3 stage).ResultsWe reviewed 293 RP specimens (median follow-up 99 months, 69 BCR). Forty-eight patients (16.4%) were treated by RP + ART. Multivariate Cox regression for BCR indicated that IDC-P had the strongest impact (hazard ratio [HR] = 2.39, 95% confidence interval [CI]:1.44–3.97), while ART reduced the risk of BCR (HR = 0.38, 95%CI: 0.17–0.85). Other HRF were all significant except for pT3b stage. IDC-P[+] patients who did not receive ART had the worst BCR-free survival (log-rank P = 0.023). Furthermore, IDC-P had the same impact on BCR-free survival as ≥1 HRF (log-rank P = 0.955).ConclusionMen with IDC-P who did not receive ART had the highest BCR rates, and IDC-P had the same impact as ≥1 HRF, which are often used as ART indications. Once validated, ART should be considered in patients with IDC-P.

The impact of adjuvant radiotherapy on the outcome of immediate breast reconstruction after mastectomy in breast cancer patients

Background. Data allowing to estimate the impact of postoperative radiotherapy on the possibility of prosthetic breast reconstruction with silicone implants or tissue expanders are mainly presented in single-level retrospective cohort studies.
 Material and methods. We searched for scientific papers in English published from January 1, 2000 to September 30, 2018 in the PubMed/MEDLINE database. The study parameters included demographic data, the method of breast reconstruction, information about adjuvant radiotherapy parameters, the incidence of postoperative complications.
 Results and discussion. Having studied the data about immediate prosthetic breast reconstruction with silicone implant or a tissue expander performed after mastectomy in 3,654 breast cancer patients. The complications after surgery were reported in 40% of all clinical observations. In 15% of cases, the specialists stopped the attempts to perform breast reconstruction. In general, the aesthetic results of immediate prosthetic breast reconstruction performed before postop radiotherapy are far from being perfect. Nevetheless, most patients are satisfied with them after the surgery.
 Conclusion. Adjuvant radiotherapy has a negative impact on the results of immediate prosthetic breast reconstruction after mastectomy. Despite this, the need for radiotherapy should not be regarded as an absolute contraindication for the immediate breast reconstruction with silicone implants and tissue expanders.

Role of postoperative radiotherapy in pT3N0 rectal cancer: A risk-stratification system based on population analyses.

The impact of adjuvant radiotherapy in pT3N0 rectal cancer is controversial. We aimed to determine the risk factors for cancer‐specific survival (CSS) among these patients and to develop a risk‐stratification system to identify which of these patients would benefit from adjuvant radiotherapy. In this review of the Surveillance, Epidemiology, and End Results database (2010‐2014), we analyzed the data of pT3N0 rectal cancer patients who had not undergone neoadjuvant radiotherapy. Prognostic factors were identified using the Cox proportional hazards model, and risk scores were derived according to the β regression coefficient. A total of 1021 patients were identified from the database search. The overall 5‐year CSS was 86.31%. Multivariate analysis showed that age (P < 0.001), tumor differentiation (P = 0.044), number of nodes resected (P = 0.032), marital status (P = 0.005), and radiotherapy (P = 0.006) were independent prognostic factors for CSS. A risk‐stratification system composed of age, tumor differentiation, and number of nodes resected was generated. Low‐risk patients had better CSS than high‐risk patients (92.13% vs 72.55%, P < 0.001). The addition of radiotherapy to surgery doubled the CSS among the high‐risk patients (42.06% vs 91.26%, P = 0.001) but produced no survival benefit among the low‐risk patients (93.36% vs 96.38%, P = 0.182). Our risk‐stratification model based on age, tumor differentiation, and number of nodes resected predicted the outcomes of pT3N0 rectal cancer patients. This model could help identify patients who may benefit from adjuvant radiotherapy.

The Impact of Adjuvant Radiation Therapy in Elderly Patients with ER Positive, Early Stage Breast Cancer

The Impact of Adjuvant Radiation Therapy in Elderly Patients with ER Positive, Early Stage Breast Cancer

Does Charlson Comorbidity Score Dilute the Survival Impact of Adjuvant Radiation Therapy in Women with Early Stage Endometrial Cancer? A Matched Analysis

To determine the impact of Age-Adjusted Charlson Comorbidity index (AACCI) score on survival outcomes in women with early stage endometrial cancer using a matched analysis methodology. After institutional review board-approval, 388 women with FIGO stage I-II uterine endometrioid carcinoma were included in this study. 194 women who had received adjuvant radiation treatment (RT) were exactly matched with 194 women who were observed after hysterectomy (1:1 match, strictly based on FIGO stage and grade). AACCI score at time of hysterectomy was determined by trained physicians based on review of all available medical records. Based on AACCI, the study cohort was divided into those with AACCI score of 0 (healthier) vs. those with a score of ≥1. Univariate and multivariate modeling with Cox regression analysis was used to determine significant predictors of recurrence-free (RFS), disease-specific (DSS) and overall survival (OS). Median follow-up for the study cohort was 58 months. While women who received adjuvant RT had a significantly higher 5-year RFS (90% vs. 78%, p=0.002), there was no significant difference in 5-year OS (88% vs. 86%, p=0.589). When accounting for comorbidity burden in women who received RT, 5-year OS was (94% vs. 81%, p=0.017) for women with AACCI score of 0 compared to those with a score of > 1, with an absolute difference of 13% at 5-year and 23% at 10 year OS. Similarly, for those who were observed after hysterectomy, 5-year OS was 91% vs 80%, p=0.011. The impact of AACCI was not statistically significant on 5-year RFS and DSS. On multivariate analyses for the entire cohort, higher AACCI score, older age, tumor grade (3 vs 1), and lymphovascular space invasion (LVSI) were significantly independent predictors for shorter OS. LVSI and grade 3 were the only two independent predictors of DSS. The lack of adjuvant RT and the presence of LVSI were significant predictors of worse RFS. Comorbidity burden is just as important as traditional prognostic variables for predicting overall survival in women with early-stage endometrioid endometrial carcinoma. Its prognostic impact should be accounted for in future prospective studies of women with endometrial cancer. On the other hand, its prognostic impact was not observed for RFS and DSS.

The Impact of Adjuvant Radiation Therapy and Elective Nodal Irradiation in Early Stage/Low Grade versus Advanced Stage/High Grade Olfactory Neuroblastoma

Olfactory neuroblastoma (ONB) is a rare head and neck cancer originating from neural crest cells of the olfactory membrane located in the roof of the nasal fossa. Several retrospective studies have shown surgical resection, followed by adjuvant radiotherapy, to be superior to either modality alone. However, even with bi-modality or even tri-modality therapy ONB patients with high Hyams grade (HHG) and advanced Kadish stages (AKS), C or D, have worse clinical outcomes compared to low Hyams grade (LHG) and early Kadish stages (EKS), A or B. This study evaluates clinical outcomes in ONB patients, comparing adjuvant radiation therapy versus surgery alone in EKS. In addition we evaluated the impact of adjuvant radiotherapy including elective nodal irradiation (ENI). Forty-one ONB patients treated with surgical resection at our institution from 1996 to 2017 were identified. Two patients died following surgery and were excluded from the analysis. Univariate, multivariate, and survival analysis was performed with comparative analysis between radiation of the primary site and ENI. Median follow-up time in this cohort was 59 months (range 5.2-236). The median overall survival (OS) and disease free survival (DFS) for the entire cohort was 15 years and 7.6 years, respectively. The five-year cumulative OS and DFS was 83% and 72%, respectively. Ten patients (26%) had ONBs classified as EKS and 29 patients (75%) had AKS tumors. The 5 year OS for ONBs with LHG was 100% compared to 65% for those with ONBs with HHG (p=.017). 66% of the EKS patients were also LHG compared to only 28% LHG in AKS patients (p=.057). The 5 year OS/DFS was 100%/100%, 100%/66%, 100%/75%, and 59%/47% for EKS/LHG, EKS/HHG, AKS/LHG, and AKS/HHG, respectively (p=0.07). Five patients in the EKS group received surgical resection alone, and there were no observed deaths or recurrences with a median follow up of 44 months (range 5-235 months). 31 (79%) patients in the entire cohort presented with node-negative disease. 13 (56%) of the node-negative patients received ENI. There were six nodal-failures in the entire cohort, with one failure 16 years following treatment (median 59 months, range 6-165 months). In node-negative patients the 10 year nodal-failure rate was reduced from 38% (3/8) in patients treated with primary site radiation alone to 0% (0/9) with the addition of ENI (p=.04). In this retrospective review, patients with both AKS and HHG have significant worse clinical outcomes compared to EKS and LHG. In EKS patients, surgery alone resulted in long term OS and DFS. For patients with node negative disease at presentation (other than those with EKS who did not undergo radiation), ENI resulted in significant reduction in the regional failure. In select patients presenting EKS and LHG ONB, surgical resection alone can be considered. Furthermore ENI should be standard of radiation therapy and long term follow up is recommended.

The role of radiotherapy in elderly women with early-stage breast cancer treated with breast conserving surgery.

To analyze the impact of adjuvant radiotherapy (RT) on ipsilateral breast recurrence (IBR) and overall survival (OS) in patients older than 69 years with early-stage breast cancer. From January 2007 to June 2015, we analyzed retrospectively 137 women with estrogen receptor-positive T1-2 invasive breast cancer, with negative axillary lymph nodes, dividing them into 2 subgroups: 70 to 79 years and older than 79 years. After a median follow-up of 43.2 months, the 3-year IBR-free survival in patients treated with surgery plus RT was 98.8% and 92.1% in patients treated with surgery alone, with a significant difference (p = .01). Radiotherapy did not impact overall survival (p = .10). A higher percentage of patients aged between 70 and 79 years received RT after conservative surgery if compared with the older subgroup (p < .01). In elderly women, adjuvant RT reduced the IBR, but did not improve OS.

Testing the impact of adjuvant radiotherapy (aRT) after radical prostatectomy (RP) on overall mortality (OM) in prostate cancer patients with pathologically node positive disease: A nationwide analysis.

5035Background: Using institutional data, we have previously identified sub-groups of patients with pN1 prostate cancer, who can benefit from aRT plus adjuvant hormonal therapy (aHT) after RP. Our ...

Adjuvant Radiation is Associated with Improved Survival for Select Patients with Non-metastatic Adrenocortical Carcinoma.

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy for which surgery is the mainstay of treatment and for which adjuvant radiation is infrequently employed; however, small, single-institution series suggest adjuvant radiation may improve outcomes. All patients with non-metastatic ACC treated with either surgery alone or surgery followed by adjuvant radiation were identified in the 2004-2013 National Cancer Database. Factors associated with receipt of radiation and the impact of adjuvant radiation on survival were determined by multivariable analysis. Of 1184 patients, 171 (14.4%) received adjuvant radiation. Patient demographics were similar between the two groups, but those receiving radiation were more likely to have had positive margins following surgery (37.4 vs. 14.6%; p < 0.001), evidence of vascular invasion (14.0 vs. 5.1%; p = 0.05), and receive concurrent chemotherapy (57.3 vs. 28.8%; p < 0.001). After adjustment for tumor and other treatment factors, only positive margins following surgery was associated with an increased likelihood of receiving adjuvant radiation (odds ratio 3.84, 95% confidence interval [CI] 1.95-7.56). Radiation therapy did not confer a difference in median overall survival in the general cohort. However, for patients with positive margins, adjuvant radiation was associated with a 40% decreased yearly risk of death after adjustment for concurrent chemotherapy (hazard ratio 0.60, 95% CI 0.40-0.92; p = 0.02). This survival advantage was not evident for other traditional high-risk features. Adjuvant radiation appears to decrease the risk of death in ACC patients with positive margins following surgical resection, but only a small percentage are currently receiving radiation. Multidisciplinary treatment with surgery and radiation should be considered for these patients.

Impact of Adjuvant Radiotherapy in Node-positive Prostate Cancer Patients: The Importance of Patient Selection

Using institutional data, we have previously developed an algorithm to identify the optimal candidates for adjuvant radiotherapy (aRT) among men with pN1 prostate cancer (PCa) at radical prostatectomy (RP). This study aimed to test the external validity of our previous findings using a nationwide database while focusing on overall mortality as an endpoint. To this end, we identified 5498 pN1 PCa patients who were treated with RP, pelvic lymph node dissection, and androgen deprivation therapy with or without aRT, within the National Cancer Database, between 2004 and 2015. Patients were divided into five groups based on our previously published algorithm. Similar to our previous report, multivariable Cox regression analysis showed that only two of these groups benefit from aRT: (1) those with one to two positive nodes, pathological Gleason score 7–10, and pT3b/4 disease or positive surgical margins (hazard ratio [HR]=0.75); and (2) those with three to four positive nodes, regardless of local tumor characteristics (HR=0.57, both p=0.01). In the remaining patients (25% of the cohort), aRT had no significant survival benefit. Results were confirmed on sensitivity analyses using 1:1 propensity score-matched cohorts, excluding men who died within 3 yr of surgery and using cut-off of 6 mo post-surgery to identify receipt of aRT. Our findings corroborate the validity of our previously published criteria and highlight the importance of patient selection in pN1 PCa patients who are considered for aRT.

Adjuvant radiotherapy following pancreaticoduodenectomy for ampullary adenocarcinoma improves survival in node-positive patients: a propensity score analysis.

This study aimed to evaluate the impact of adjuvant radiotherapy in patients undergoing pancreaticoduodenectomy (PD) for ampullary adenocarcinoma. Using the Surveillance, Epidemiology, and End Results, patients with non-metastatic ampullary adenocarcinoma between 2004 and 2013 were identified. Cancer-specific survival and overall survival were estimated using Kaplan-Meier and Cox regression to obtain adjusted hazard ratio of survival. In this study, 1106 patients with ampullary adenocarcinoma were identified, of which 27% received adjuvant radiotherapy and the remaining 73% (803/1106) patients did not receive any adjuvant radiotherapy. In the matched cohort, there were still no significant difference in CSS (median 41 vs 35, p=0.28) and OS (median 32 vs 30, p=0.26) between patients receiving adjuvant radiotherapy and those under observation alone. However, in patients with N2 (Fig.4) disease, both CSS (median 27 vs 19months, p=0.0044) and OS (median 23 vs 17months, p=0.0091) were significantly longer for patients receiving adjuvant radiotherapy. In summary, adjuvant radiotherapy following PD for ampullary adenocarcinoma significantly improves survival in patients with N2 disease. Future studies defining "high-risk" groups using larger cohorts will enable reliable appraisal on the benefit of adjuvant radiotherapy to allow for a more personalized approach in treating patients.