Receipt Of Postoperative Radiotherapy Research Articles

21-gene recurrence score predictive of the benefit of postoperative radiotherapy after breast-conserving surgery for elderly patients with T1N0 and luminal breast cancer.

To assess the predictive value of the 21-gene recurrence score (RS) on the survival outcomes of postoperative radiotherapy (PORT) in elderly patients with T1N0 luminal breast cancer after breast-conserving surgery. We retrospectively included patients aged ≥ 70years and diagnosed with T1N0 luminal BC between 2004 and 2015 using the data from the Surveillance, Epidemiology, and End Results. The RS groups were categorized using the TAILORx criteria as follows: low risk (RS < 11) (LR), intermediate risk (RS 11-25) (IR), and high risk (RS > 25) (HR). Kaplan-Meier analysis, propensity score matching (PSM), and Cox proportional hazards analysis were used for statistical analysis. We included 5901 patients in the analysis. Of the patients, 4492 (76.1%) underwent PORT, while 1409 (23.9%) did not receive PORT. There were 1588 (26.9%), 3613 (61.2%), and 700 (12.0%) patients classified as LR, IR, and HR, respectively. There were 1182 (74.4%), 2773 (76.8%), and 537 (76.7%) patients in the LR, IR, and HR groups receiving PORT, respectively (P = 0.182). A total of 1353 pairs of patients were completely matched using PSM. PORT was independently associated with better overall survival (OS) (P < 0.001) and breast cancer-specific survival (BCSS) (P = 0.015) in the entire cohort. The sensitivity analyses showed that the receipt of PORT was not associated with OS (P = 0.887) and BCSS (P = 0.861) in the LR group. However, the receipt of PORT was associated with OS (P < 0.001) and BCSS in the IRHR group (P = 0.026). Our study highlights the possible role of the 21-gene RS in predicting the survival outcomes of PORT following BCS in elderly patients with T1N0 luminal breast cancer.

Association between postoperative radiotherapy for young-onset head and neck cancer and long-term risk of second primary malignancy: a population-based study

BackgroundSecond primary malignancy (SPM) represents the leading long-term cause of death among patients with index head and neck squamous cell carcinoma (HNSCC). We aimed to quantify the association between postoperative radiotherapy (PORT) and the risk of SPM development for index HNSCC among adolescent and young patients, who are particularly vulnerable to radiation-associated impacts due to their increased tissue susceptibilities and longer life expectancies.MethodsThis study was conducted using the Surveillance, Epidemiology, and End Results (SEER) database to collect the data of 5 year survivors of index young-onset HNSCC from 1975 to 2011. The outcome of interest was SPM, a new, metachronous malignancy after the index HNSCC. Standardized incidence ratios (SIRs) and excess absolute risks (EARs) were used to quantify the PORT-associated risks externally, and relative risks (RRs) were estimated by the multivariate Poisson regression analysis to quantify the PORT-associated risks internally.ResultsOf the included 2771 5 year survivors with index young-onset HNSCCs, the receipt of PORT (37.6%) was associated with higher risk of SPMs (RR, 1.23; 95% CI 1.07 to 1.43). PORT-associated risks were elevated for the majority of sites, including head and neck (RR, 1.19; 95% CI 0.95 to 1.50) and lung (RR, 1.67; 95% CI 1.18 to 2.34). With regarding to the subsites of head and neck, RRs were above unity in oral cavity squamous cell carcinoma (SCC) (RR, 1.68; 95% CI 1.39 to 2.03) and laryngeal SCC (RR, 1.02; 95% CI 0.73 to 1.43). A relatively greater RR was observed for patients younger than 35 years (RR, 1.44, 95% CI 0.37 to 5.57) and those diagnosed with localized diseases (RR, 1.16, 95% CI 0.9 to 1.5). PORT-associated risks were increased remarkably after 15 years of follow-up (RR, 1.24; 95% CI 0.97 to 1.58).ConclusionsAn association was discovered between PORT treatment and increased long-term risk of SPM among patients with index young-onset HNSCC. The findings suggest long-term follow-up surveillance for these patients, particularly those with oral cavity SCC or laryngeal SCC.

Prediction model to estimate overall survival benefit of postoperative radiotherapy for resected major salivary gland cancers

ObjectivesTo develop and validate a prediction model to estimate overall survival (OS) with and without postoperative radiotherapy (PORT) for resected major salivary gland (SG) cancers. Materials and MethodsAdults in the National Cancer Database diagnosed with invasive non-metastatic major SG cancer between 2004 and 2015 were identified. Exclusion criteria included prior malignancy, pT1N0 or unknown stage, no or unknown surgery, and neoadjuvant therapy. Cox proportional hazards models evaluated the effect of covariates on OS. A multivariate regression model was utilized to predict 2-, 5-, and 10-year OS. Internal cross-validation was performed using 50–50 hold-out and Harrell’s concordance index. Results18,400 subjects met inclusion criteria, including 9,721 (53%) who received PORT. Distribution of SG involvement was 86% parotid, 13% submandibular, and 1% sublingual. Median follow-up for living subjects was 4.9 years. PORT was significantly associated with improved OS for the following subgroups by log-rank test: pT3 (p < 0.001), pT4 (p < 0.001), high grade (p < 0.001), node-positive (p < 0.001), and positive margin (p < 0.001). The following variables were incorporated into a multivariate model: age, sex, Charlson-Deyo comorbidity score, involved SG, pathologic T-stage, grade, margin status, ratio of nodal positivity, and PORT. The resulting model based on data from 6,138 subjects demonstrated good accuracy in predicting OS, with Harrell’s concordance index of 0.73 (log-rank p < 0.001). ConclusionThis cross-validated prediction model estimates 2-, 5-, and 10-year differences in OS based on receipt of PORT for resected major SG cancers using readily available clinicopathologic features. Clinicians can utilize this tool to aid personalized adjuvant therapy decisions.

Effectiveness of Postoperative Radiotherapy in Patients with Atypical Meningiomas After Gross Total Resection: Analysis of 260 Cases

It remains controversial whether patients with atypical meningiomas can benefit from postoperative radiotherapy (PORT) after gross total resection (GTR). This study aimed to explore the effectiveness of PORT in patients with atypical meningiomas after GTR based on our single-center data with a relatively large sample size. Patients with atypical meningiomas who underwent GTR in our center were reviewed. Univariable and multivariable Cox proportional hazard models were conducted for survival analyses. Kaplan-Meier survival curves were generated, and 5-year progression-free survival (PFS) rates were calculated. This study enrolled 260 patients. PORT was not associated with PFS (P= 0.507). Sex (P= 0.006, hazard ratio 0.418, 95% confidence interval 0.224-0.781), age (P= 0.032, hazard ratio 1.032, 95% confidence interval 1.003-1.061), and tumor location (P= 0.026, hazard ratio 0.199, 95% confidence interval 0.048-0.824) were independent predictors of PFS. The 5-year PFS rate of patients receiving PORT (85.6%) was similar to that of patients not receiving PORT (84.8%). The 5-year PFS rate was 100% in patients with convexity atypical meningiomas regardless of whether or not they received PORT. PORT after GTR may not prolong PFS in patients with atypical meningiomas. Patients with convexity atypical meningiomas had favorable outcomes after GTR regardless of receipt of PORT.

Elective Neck Dissection, but Not Adjuvant Radiation Therapy, Improves Survival in Stage I and II Oral Tongue Cancer with Depth of Invasion >4 mm.

Purpose/objective(s)In early-stage, node negative oral tongue cancer, there is limited data supporting tumor depth of invasion (DOI) as an indication for post-operative radiotherapy (PORT) to the primary site. The primary aim of this study is to examine the effect of tumor DOI and PORT on overall survival (OS).Materials and methodsThe National Cancer Database (NCDB) was used to query patients with AJCC stage I and II oral tongue cancer (2006-2013). Patients were stratified by receipt of PORT, elective neck dissection (ND), and DOI (≤4 mm or >4 mm). Kaplan-Meier analysis was performed to compare OS (using the log-rank test) between PORT versus no-PORT. Multivariable Cox proportional hazards regression model performed to evaluate the independent effect of PORT and neck dissection on OS.ResultsAmong 939 patients, 69.3% were clinical stage I, 67.4% received ND, 23.4% had DOI >4 mm, and 10.4% received PORT. The addition of PORT did not improve OS with tumor DOI ≤4 mm (p = 0.634) or >4 mm (p = 0.816). The addition of elective neck dissection improved OS for DOI >4 mm (p = 0.010), but not for ≤4 mm (p = 0.128). On multivariable analysis, ND improved OS if DOI >4 mm (HR, 0.37; 95% CI, 0.17-0.81 [p = .012]), when also controlling for age, sex, PORT status, clinical stage, and pathological stage.ConclusionTumor DOI should not be used as a sole indication for PORT in early stage oral tongue cancers. Elective neck dissection at the time of excision of the primary tumor results in higher OS for tumors with DOI >4 mm.

Nomogram to Predict Survival Benefit of Postoperative Radiotherapy for Major Salivary Gland Cancers

There are no randomized data to support the use of postoperative radiotherapy (PORT) for major salivary gland malignancies. Our objective was to develop and validate a nomogram to estimate overall survival (OS) with and without PORT. Adults in the National Cancer Database diagnosed with invasive non-metastatic major salivary gland cancer between 2004-2015 were identified. Exclusion criteria included prior malignancy, pT1N0, no/unknown surgery, neoadjuvant therapy, PORT dose <50 Gy or >75 Gy, PORT to a non-head/neck site, PORT started >9 weeks from surgery, and PORT duration >9 weeks. Ratio of nodal positivity (N+ ratio) was defined as number of nodes positive among nodes resected. Cox proportional hazards models determined the effect of covariates on OS. A multivariate regression model was used to generate a nomogram to predict 2-, 5-, and 10-year OS. Cross-validation using 500 random 50-50 hold-out samples was performed. All p-values are two-sided. There were 18,400 subjects who met inclusion criteria, of which 9,721 (53%) received PORT. Subjects who received PORT had significantly worse adverse pathologic features compared to those treated with surgery alone: pT3-4 (54% vs 39%, p<0.01), high grade (60% vs 35%, p<0.01), lymphovascular invasion (34% vs 17%, p<0.01), >0.1 N+ ratio (36% vs 23%, p<0.01), extranodal extension (23% vs 15%, p<0.01), major nerve involvement (12% vs 6%, p<0.01), and positive margin (45% vs 25%, p<0.01). Median age at diagnosis for both cohorts was 65 (p=0.07). Distribution of gland involvement was 86% parotid, 13% submandibular, and 1% sublingual. Median follow-up for living subjects was 4.9 years. PORT was significantly associated with improved OS for the following subgroups by log-rank test: pT3 (p<0.01), pT4 (p<0.01), high grade (p<0.01), node positive (p<0.01), and positive margin (p<0.01). The variables listed in the table below were incorporated into a nomogram using data from 6,138 subjects. The resulting nomogram demonstrated good accuracy in predicting OS, with a concordance index of 0.719. Our cross-validated nomogram predicts the 2-, 5-, and 10-year differences in OS based on receipt of PORT for major salivary gland cancers using readily available clinicopathologic features. The nomogram will be made publicly available online.Abstract 1147; Table 1VariableHR95% CIPAge at diagnosis1.041.03 – 1.04<0.01Male sex (ref: female)1.281.17 – 1.39<0.01Charlson-Deyo comorbidity score (ref: 0)11.191.08 – 1.31<0.0121.581.32 – 1.90<0.01≥31.801.33 – 2.44<0.01Primary site (ref: parotid)Submandibular1.311.16 – 1.48<0.01Sublingual0.680.38 – 1.230.21Pathologic T-stage (ref: 1)21.140.96 – 1.350.1331.591.35 – 1.88<0.0141.891.60 – 2.23<0.01N+ ratio (ref: 0)>0 and ≤0.101.451.29 – 1.63<0.01>0.1 and <0.51.741.58 – 1.93<0.01≥0.52.131.91 – 2.37<0.01Tumor grade (ref: low)Intermediate1.701.43 – 2.02<0.01High2.091.77 – 2.47<0.01Positive margin (ref: negative)1.281.18 – 1.38<0.01Yes PORT (ref: no PORT)0.630.58 – 0.68<0.01 Open table in a new tab

Pathologic staging changes in oral cavity squamous cell carcinoma: Stage migration and implications for adjuvant treatment.

The eighth edition of the AJCC Cancer Staging Manual (AJCC 8) incorporates depth of invasion (DOI) into the pathologic tumor (pT) classification and pathologic extranodal extension (pENE) into the pathologic nodal (pN) classification for oral cavity squamous cell carcinoma (OCSCC). This study evaluated the incidence and prognostic importance of stage migration as a result of these changes in the AJCC 8 staging system. From the National Cancer Database, cohorts were identified from patients with OCSCC undergoing definitive surgery between 2004 and 2013 for pT (n=7184), pN (n=13,627), and pathologic stage (pStage) analysis (n=5580). DOI and pENE were prognostic in all groups except for pN3 according to the seventh edition of the AJCC Cancer Staging Manual (AJCC 7). Upstaging was seen in 12.4% of patients for the pT classification, in 13.3% for the pN classification, and in 24.8% for the overall pStage grouping. Notably, upstaging led to similar or improved 5-year overall survival (OS) for every AJCC 8 pT/N classification except pStage IVB. Patients with AJCC 7 pT1 tumors that were upstaged to AJCC 8 pT3 tumors had improved OS in comparison with the remainder of the pT3 group (71.7% vs 43.7%; P<.0001). A multivariable analysis of upstaged pT3N0 patients demonstrated a reduced risk of death with the receipt of postoperative radiotherapy (PORT; hazard ratio, 0.56; 95% confidence interval, 0.33-0.95; P=.03). Upstaging is common in AJCC 8, and patients with upstaged tumors demonstrate improved survival; these factors should be kept in mind when one is interpreting data with the new staging system. PORT may reduce deaths among newly upstaged pT3N0 patients, and further study is needed in this area.

Effectiveness of Postoperative Radiotherapy on Atypical Meningioma Patients: A Population-Based Study.

Purpose: It is controversial whether atypical meningioma patients undergoing gross-total resection (GTR) can benefit from postoperative radiotherapy (PORT). This study aimed to investigate the effectiveness of PORT on atypical meningioma patients.Methods: Patients diagnosed with atypical meningioma from 2008 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan–Meier survival curves were generated, and the log-rank test was used to compare the differences among groups. Univariable and multivariable COX regressions were conducted for survival analyses.Results: A total of 1,014 patients were enrolled. The 5-years survival rate of the overall patients was 79.0%. PORT was performed in 315 (31.1%) patients. The utilization rates of PORT in patients undergoing GTR and undergoing subtotal resection (STR) were 26.7% and 42.2%, respectively. For patients undergoing STR, log-rank test showed that overall survival (OS) time was significantly longer in patients receiving PORT than those not (p = 0.026). For patients undergoing GTR, OS time did not show significant association with PORT (p = 0.339). In addition, patients undergoing STR with PORT had no significantly different OS time compared with those undergoing GTR with PORT (p = 0.398). Multivariable Cox regression analysis showed that receipt of PORT (p = 0.187) was not an independent predictor of OS after adjustment.Conclusion: PORT may not prolong the OS in atypical meningioma patients undergoing GTR. However, patients undergoing STR may benefit from PORT and achieve similar OS to those undergoing GTR.

21-Gene Recurrence Score Assay and Outcomes of Adjuvant Radiotherapy in Elderly Women With Early-Stage Breast Cancer After Breast-Conserving Surgery.

Introduction: To assess the role of the 21-gene recurrence score (RS) assay on decision-making of postoperative radiotherapy (RT) following breast-conserving surgery (BCS) in elderly women with early-stage breast cancer.Methods: The 21-gene RS for elderly (≥65 years) women with stage T1–2N0M0 estrogen receptor-positive breast cancer who underwent BCS from 2004 to 2015 was obtained from the Surveillance, Epidemiology, and End Results program. We estimated the association of 21-gene RS and adjuvant RT related to breast cancer-specific survival (BCSS) using propensity score matching (PSM).Results: We identified 18,456 patients, of which 15,326 (83.0%) received postoperative RT. Of identified patients, 58.9, 34.0, and 7.1% of patients had a low-, intermediate-, and high-risk RS, respectively. Receipt of postoperative RT was not related to the year of diagnosis according to the 21-gene RS groups. Multivariate analysis suggested that receipt of postoperative RT was an independent predictor of better BCSS before (hazard ratio [HR] 0.587, 95% confidence interval [CI] 0.426–0.809, P = 0.001) and after (HR 0.613, 95%CI 0.390–0.963, P = 0.034) PSM. However, subgroups analyses indicated that receipt of postoperative RT was related to better BCSS in women with intermediate-risk RS before (HR 0.467, 95%CI 0.283–0.772, P = 0.003) and after (HR 0.389, 95%CI 0.179–0.846, P = 0.017) PSM, but not in women with low- and high-risk RS groups before and after PSM.Conclusions: Although causation cannot be implied, adjuvant RT in elderly women was associated with a greater effect size in patients with an intermediate-risk RS.

The effects of postoperative radiotherapy on survival outcomes in patients under 65 with estrogen receptor positive tubular breast carcinoma

BackgroundThe value of postoperative radiotherapy in tubular breast carcinoma patients under 65 years is uncertain.MethodsData on patients with estrogen receptor positive T1N0M0 tubular breast carcinoma who were younger than 65 years and who received breast-conserving surgery between 2000 and 2013 were retrieved from the Surveillance, Epidemiology and End Results database. Demographic, clinicopathologic features, and receipt of postoperative radiotherapy were analyzed to investigate effects on survival.ResultsData from 2442 patients were analyzed, of whom 2020 (82.7%) received postoperative radiotherapy and 422 (17.3%) did not. The number of patients treated with or without postoperative radiotherapy showed no differences during the study period (p = 0.184). Radiotherapy was more likely to be administered in patients with well differentiated tumors. Multivariate Cox analysis showed that postoperative radiotherapy delivery was significantly correlated with better breast cancer-specific survival (BCSS) (hazard ratio [HR] 0.297, 95% confidence interval [CI] 0.105–0.836, p = 0.022) and overall survival (OS) (HR 0.656, 95% CI 0.441–0.978, p = 0.038). Ten 10-year BCSS was 99.3% in patients who received postoperative radiotherapy and 98.1% in those who did not (p = 0.020), and 10-year OS was 93.4 and 91.0%, respectively (p = 0.029). Postoperative radiotherapy increased BCSS and OS in the subgroups of age < 50 years, non-Hispanic white, well differentiated tumors, and progesterone receptor positive tumors.ConclusionsPostoperative radiotherapy after breast-conserving surgery improved survival outcomes in tubular breast carcinoma patients aged < 50 years. However, omitting postoperative radiotherapy may not decrease survival in patients aged ≥50 years.

Effect of postoperative radiotherapy on survival in duodenal adenocarcinoma: a propensity score-adjusted analysis of Surveillance, Epidemiology, and End Results database.

The use of adjuvant treatment has not been sufficiently investigated in duodenal adenocarcinoma. This study evaluated the effect of postoperative radiotherapy (PORT) on survival outcomes in this rare malignancy. We identified patients who were diagnosed between 2004 and 2013 in the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and disease-specific survival (DSS) were analyzed before and after propensity score matching. Among the 701 eligible patients, 116 (17%) underwent PORT. There were no significant differences in OS and DSS according to receipt of PORT in the unmatched population (P=0.982 and 0.496, respectively), whereas the propensity-matched analysis showed improved OS and DSS with PORT (P=0.053 and 0.019, respectively). No receipt of PORT was an independent poor prognostic factor in multivariate analysis of both OS (P=0.022) and DSS (P=0.005). The potential survival benefits of PORT were observed in subgroups of T4 stage, larger tumor size, higher lymph node ratio, and total/radical resection. We provide useful insights into the therapeutic role of PORT in adenocarcinoma of the duodenum. Adjuvant strategy with PORT needs to be considered in locally advanced tumors.

Post-operative radiotherapy is associated with improved survival in esophageal cancer with positive surgical margins.

The optimal treatment for early-stage esophageal cancer with positive surgical margins after an upfront esophagectomy is not well-defined. This study investigates the effect of post-operative radiotherapy (PORT) on overall survival (OS) in clinical stage I-II patients with positive margins. We identified patients diagnosed between 2004 and 2012 with clinical stage I-II esophageal carcinoma from the National Cancer Data Base (NCDB) who underwent an upfront esophagectomy. For those patients with positive margins, administration of PORT was recorded, and OS was compared by the Kaplan-Meier estimator and log-rank test. Multivariable Cox regression analysis was performed to identify variables associated with improved survival. Among the 3,490 patients identified, 209 (5.8%) had positive margins. One hundred forty-two (67.9%) patients did not receive PORT while 67 (32.1%) did receive PORT. Compared to those receiving PORT, patients who did not receive PORT were significantly older (68.5 vs. 64.0 years, P=0.003), more likely to have pN0 disease (50.7% vs. 35.4%, P=0.026), and less likely to receive postoperative chemotherapy (21.1% vs. 86.6%, P<0.001). On multivariable logistic regression, only receipt of chemotherapy predicted for receipt of PORT (OR: 25.6, 95% CI: 9.9-65.8, P<0.001). OS was significantly higher for patients receiving PORT compared to those who did not (median OS: 32.2 vs. 16.9 months, log-rank P=0.008). Multivariable analysis confirmed an association with PORT and improved OS (HR: 0.39, 95% CI: 0.27-0.60, P<0.001). Subset analysis demonstrated that the OS benefit of PORT persisted in those patients who received adjuvant chemotherapy (HR: 0.33, 95% CI: 0.19-0.57, P<0.001). PORT is associated with improved OS in clinical stage I-II esophageal cancer patients after an upfront esophagectomy with positive margins. In the absence of prospective randomized data, our findings suggest that PORT should be strongly considered in the setting of early-stage esophageal cancer resected with positive margins.

Improved Survival With Increased Time-To-Radiation and Sequential Chemotherapy After Surgery for pN2 Non–Small-cell Lung Cancer

BackgroundCurrently, the ideal timing for postoperative radiotherapy (PORT) and chemotherapy is unknown. The present study evaluated their relative timing on overall survival (OS) using the National Cancer Database (NCDB). Materials and MethodsThe NCDB was queried for patients from 2004 to 2012 with resected non–small-cell lung cancer (NSCLC), pathologically involved N2 (pN2) nodes, and negative margins. All patients underwent adjuvant chemotherapy and external beam radiotherapy. The time to radiation (TTR) was determined from the date of surgery to the start of PORT, with the exclusion of those receiving PORT < 4 weeks or > 24 weeks postoperatively. Early and late TTR was dichotomized at 8 weeks after receiver operating characteristic analysis. Multivariate Cox regression analysis was conducted to predict the variables significantly associated with survival. ResultsA total of 1629 patients were eligible for analysis. Of the 1629 patients, 703 had received PORT < 8 weeks and 926 had received PORT ≥ 8 weeks postoperatively. The receipt of PORT after 8 weeks was associated with better OS (P = .0044). No significant differences were found in survival in the concurrent group comparing early and later TTR (P = .9119). However, a significant OS benefit was found for sequential chemotherapy with an increased TTR (P = .0045). Older age, male sex, shorter distance traveled, increased nodal positivity, larger tumor size, higher Charlson/Deyo comorbidity score, and early TTR were associated with inferior survival on multivariate analysis. ConclusionA TTR of ≥ 8 weeks with sequential chemotherapy in the setting of PORT was associated with improved survival in patients with NSCLC with pN2 nodes.

Improved survival with postoperative radiotherapy in thymic carcinoma: A propensity-matched analysis of Surveillance, Epidemiology, and End Results (SEER) database

ObjectivesThymic carcinoma is a rare and aggressive malignancy with poor prognosis. Although postoperative radiotherapy (PORT) is used for obtaining better locoregional tumor control, its association with survival has not been established. This study evaluated the prognostic impact of PORT in thymic carcinoma. Materials and methodsWe identified patients diagnosed with thymic carcinoma between 2004 and 2013 using the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching with Kaplan-Meier and Cox-regression analyses were used to assess prognosis. ResultsIn the unmatched population (n=312), 184 (59%) patients underwent PORT. The 5-year overall survival rates were better with receipt of PORT, both before and after matching (P=0.012 and 0.007, respectively). After adjusting for related covariates (n=256), age ≥63 years (P=0.023), Masaoka stage III (P=0.028) and IV (P<0.001), debulking surgery (P=0.021), and no receipt of PORT (P=0.013) were independently poor prognostic factors. In subgroup analyses, favorable survival impacts of PORT were observed for Masaoka stage III tumors (hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.15–0.66), tumors sized >6.0cm (HR 0.48, 95% CI 0.26–0.89), node-negative status (HR 0.58, 95% CI 0.33–1.00), and surgical extent of local excision or partial removal (HR 0.44, 95% CI 0.22–0.86). ConclusionOn SEER analysis, survival benefits of PORT in thymic carcinoma were demonstrated. With strong prognostic associations of Masaoka stage and types of surgery, PORT should be considered for non-metastatic locally advanced tumors with limited surgical resection.

Role of Postoperative Radiotherapy in Pathologic Stage IIIA (N2) Non–Small Cell Lung Cancer in a Prospective Nationwide Oncology Outcomes Database

IntroductionThe role of postoperative radiotherapy (PORT) in the treatment of pathologic stage IIIA (N2) NSCLC remains controversial. We investigated practice patterns and outcomes for these patients in a prospectively maintained nationwide oncology outcomes database. MethodsPatients with known histologic features of pathologic stage IIIA (N2) NSCLC who underwent an operation with negative margins and received adjuvant multiagent chemotherapy from 2004 to 2013 were identified from the National Cancer Data Base and stratified by the use of PORT. Multivariable logistic regression modeling was used to examine factors associated with receiving PORT, and multivariable proportional hazards regression was used to examine the association of treatment and mortality, adjusting for demographic, socioeconomic and clinicopathologic factors. Landmark analysis and covariate balancing propensity score (CBPS) weighting were also explored to account for immortal time bias and nonrandomization. ResultsA total of 2691 patients were identified, with a median follow-up of 32.32 months. In multivariable analysis, improved overall survival was associated with multiple factors, including younger age, female sex, lower Charlson-Deyo comorbidity index, histologic type (with squamous cell being better than adenocarcinoma), smaller tumor size, lower pathologic T stage, surgical procedure (with pneumonectomy or lobectomy being better than sublobar resection), and receipt of PORT (all p < 0.05). Before landmark analysis, the hazard ratio (HR) showed an overall survival benefit for patients receiving PORT (adjusted HR = 0.83, 95% CI [confidence interval]: 0.72–0.95; p = 0.008). This benefit remained significant after CBPS weighting (HR = 0.81, 95% CI: 0.70–0.94, p = 0.005), almost significant after landmark analysis (adjusted HR = 0.84, 95% CI: 0.69–1.007, p = 0.059), and significant after landmark analysis with CBPS weighting (HR = 0.77, 95% CI: 0.63–0.94, p = 0.009). Median survival past landmark time was 27.43 months in the PORT group and 25.86 months in the non-PORT group. Factors significantly associated with receiving PORT were facility location, facility type, Charlson-Deyo comorbidity index, and grade (all p < 0.05). ConclusionsImproved survival is associated with receipt of PORT for patients with pathologic stage IIIA (N2) NSCLC treated with complete resection and multiagent chemotherapy.

Postoperative Radiotherapy in Locally Invasive Malignancies of the Thymus: Patterns of Care and Survival

IntroductionOur purpose was to determine the overall survival (OS) benefit of postoperative radiotherapy (PORT) in patients with advanced thymic malignancies and the associated predictors of PORT receipt. MethodsWe queried the National Cancer Data Base for all stage II to III thymic malignancies. Trends in PORT use over time were analyzed using least squares linear regression. Factors predictive of PORT and OS were identified by using multivariate logistic and Cox regression analysis, respectively. ResultsWe identified 1156 patients between 2004 and 2012 who met the inclusion criteria. The utilization of PORT was found to increase over the study period by 41% (37% to 52% [p = 0.01]). On multivariate analysis, the factors found to be the most predictive of receipt of PORT were positive surgical margins (adjusted OR = 1.98 [p < 0.01]) and treatment at a nonacademic facility (adjusted OR = 1.44 [p = 0.01]). The 5-year OS was superior for patients receiving PORT compared with for those who did not (83% versus 79%, p = 0.03). Receipt of PORT was associated with a trend toward decreased risk for death on multivariate analysis (hazard ratio = 0.75 [p = 0.09]). In addition, a positive macroscopic margin was the most important predictor of survival (hazard ratio = 3.48 [p < 0.01]). On subgroup analysis, patients with thymic carcinoma and WHO histologic types A and AB were associated with an OS benefit with PORT, whereas types B1, B2, and B3 were not. Patients with positive margins were not associated with an OS benefit with PORT. ConclusionsThe use of PORT in patients with advanced thymic malignancies is increasing over time and is determined by both clinical and demographic factors. Receipt of PORT was associated with improved OS. The OS benefit with PORT was dependent on the WHO histologic type.

Role of Postoperative Radiotherapy in Nonlocalized Thymoma: Propensity-Matched Analysis of Surveillance, Epidemiology, and End Results Database

Because of a lack of randomized trials, the role of postoperative radiotherapy (PORT) in thymomas has not been established. This study evaluated the prognostic impact of the adjuvant treatment in surgically resected nonlocalized thymomas. Patients diagnosed between 2000 and 2010 were identified from the Surveillance, Epidemiology, and End Results database (1973-2011 registry). Cases with localized or organ-confined tumors were not included. Propensity-matched analysis was conducted considering baseline characteristics. A total of 529 patients were identified. The median age was 57 years (range, 18-86), and 345 (65%) patients received PORT. Before and after propensity score matching, overall survival (OS; p = 0.018 and 0.008, respectively) and disease-specific survival (DSS; p = 0.007 and 0.008, respectively) were better in the PORT group. In multivariate analyses of the matched population, no receipt of PORT induced poorer OS (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.27-3.09) and DSS (HR, 2.64; 95% CI, 1.32-5.29). Primary tumor extensions of adjacent organs or structures and further contiguous extensions also resulted in worse outcomes (p < 0.001 and equal to 0.039 for OS; p = 0.006 and 0.009 for DSS, respectively). In the subgroup analyses, PORT was associated with favorable OS in stages III and IV (p = 0.049 and 0.012, respectively) and DSS in stage III (p = 0.005). Regarding the independent prognostic significance of PORT, this population-based analysis demonstrates the survival benefits of PORT in relation to nonlocalized thymomas. We recommend consideration of PORT in the poor prognostic subset of stages III to IV in the contemporary era.

The role of adjuvant radiotherapy in the local management of desmoplastic melanoma.

In the current study, the authors sought to evaluate outcomes, specifically with respect to adjuvant radiotherapy (RT), for patients with desmoplastic melanoma. The records of 130 consecutive patients who presented between 1985 and 2009 with nonmetastatic desmoplastic melanoma and were treated curatively with either surgery alone (59 patients; 45%) or surgery and postoperative RT (71 patients; 55%) were retrospectively reviewed. Ages ranged from 21 years to 97 years (median age, 66 years). The location of the primary tumor was in the head and neck region in 62% of patients. Only 5 patients (4%) had lymph node involvement at the time of presentation. The median follow-up was 6.6 years (range, 11 months-24 years). Overall survival rates at 5 years and 10 years were 69% and 53%, respectively. Disease-specific survival rates were 84% and 80%, respectively, at 5 years and 10 years. The actuarial rate of local recurrence was 17% at 5 years and beyond. Of the patients who underwent surgery without receiving postoperative RT, 14 (24%) experienced local recurrence. Of the 71 patients treated with surgery and postoperative RT, 5 (7%) experienced local recurrence. In a Cox multivariate regression model, improved local control was significantly associated with the receipt of postoperative RT (P= .009). Surgery followed by postoperative RT appears to provide superior local control compared with surgery alone for patients with desmoplastic melanoma.

Postoperative radiation therapy for low‐grade glioma

The role of postoperative radiotherapy (PORT) in the management of low-grade glioma remains controversial. An analysis using data from the European Organization for Research and Treatment of Cancer 22844/22845 studies concluded that several factors portend a poor prognosis: age ≥40 years, astrocytoma histology, tumor size ≥6 cm, tumor crossing midline, and preoperative neurologic deficits. PORT may benefit patients with high-risk features. The aim of this study was to assess temporal trends and determinants of the use of PORT. By using data from the Surveillance, Epidemiology, and End Results program, the authors identified 1127 adult patients diagnosed with low-grade glioma (World Health Organization grade I and II) who underwent surgical resection between January 1, 1998 and December 31, 2006. The primary outcome was receipt of PORT. The authors performed multivariate logistic regression to examine the association between clinical, patient, and demographic characteristics and receipt of PORT. Receipt of PORT declined during the study period, from 64% of patients in 1998 to 36% of patients in 2006. On multivariate analysis, significant predictors of receipt of PORT were age ≥40 years, tumor crossing midline, and partial surgical resection. The use of PORT for patients with low-grade glioma has declined in the period from 1998 to 2006 for both low-risk and high-risk patients.

A new pathological system for grading DCIS with improved prediction of local recurrence: results from the UKCCCR/ANZ DCIS trial

Background:There is no consensus agreement regarding optimal management of locally excised ductal carcinoma in situ (DCIS) or features of greatest assistance in predicting disease behaviour. Cases in the UKCCCR/ANZ DCIS trial have been histologically reviewed to determine the features of prognostic importance.Method:A total of 72% of 1694 cases entered into the UKCCCR/ANZ DCIS trial had full pathological review. A large number of histological features were assessed, blinded to outcome and compared regarding ability to predict ipsilateral recurrence, as either DCIS or progression to invasive carcinoma.Results:Pathological features associated with ipsilateral recurrence in univariate analysis included high cytonuclear grade, larger lesion size, growth pattern, presence of necrosis or chronic inflammation, incompleteness (or uncertainty of completeness) of excision and smaller margin width. Receipt of post-operative radiotherapy was also a strong prognostic factor.We report a novel sub-division of the large group of high-grade lesions, which enables identification of a very poor prognosis sub-group; namely, DCIS that is of high cytonuclear grade, predominantly (>50%) solid architecture, bearing extensive comedo-type necrosis (>50% of ducts). In addition, we found little difference in ipsilateral recurrence rates between low- and intermediate-grade groups. Hazard ratios for low, intermediate, high and the new, very high, grade were 0.42, 0.33, 0.62 and 1.00, respectively, for ipsilateral in situ or invasive recurrence.Conclusion:We present a novel pathological classification for DCIS with substantially better prognostic discrimination for ipsilateral recurrence than the classical categorisation based on cytonuclear grade alone.