Survival Benefit Of Radiotherapy Research Articles

Survival benefits of radiotherapy in locally advanced unresectable and metastatic pancreatic cancer: a single-institution cohort and SEER database analysis

BackgroundChemotherapy (CT) remains the primary treatment for locally advanced unresectable pancreatic cancer (LAUPC) and metastatic pancreatic cancer (MPC). The role of radiotherapy (RT) in these conditions remains unclear. This study compares the outcomes of CT alone versus CT combined with RT (combined-modality therapy [CMT]) in LAUPC and MPC patients.Materials and methodsWe conducted a retrospective analysis of LAUPC and MPC patients treated with either CT or CMT from a single institution and Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier curves and Cox hazards models evaluated the association between treatment modalities and overall survival (OS). Propensity score matching (PSM) ensured balanced comparisons. Landmark analysis addressed immortal time bias. Subgroup analyses were based on clinical characteristics. eXtreme Gradient Boosting (XGBoost) and Shapley Additive Explanations (SHAP) assessed outcome prediction and influence of significant predictors.ResultsThe study included 102 patients receiving CMT and 155 receiving CT at single institution, along with 1733 CMT and 9310 CT patients from the SEER dataset. In the single-institution cohort, CMT showed superior survival compared to CT both before (median OS: 20.5 vs. 11.5 months, hazard ratio [HR]: 0.47, 95% CI: 0.34-0.65, P=0.001) and after PSM (median OS: 22.2 vs. 11.8 months, HR: 0.49, 95% CI: 0.30-0.79, P=0.003). Multivariate analyses confirmed that CMT was independently associated with improved OS both before (HR: 0.54, 95% CI: 0.38-0.77, P=0.001) and after PSM (HR: 0.45, 95% CI: 0.27-0.73, P=0.001). Landmark analysis indicated better OS for patients receiving CMT compared to CT alone. Subgroup analysis revealed an OS benefit for CMT across most subgroups. SHAP value analysis indicated that CMT was the most significant contributor to survival outcomes. SEER database validation confirmed these findings.ConclusionsThis study demonstrates that CMT significantly improves OS in LAUPC and MPC patients compared to CT alone. Integrating RT with CT could be beneficial for treating LAUPC and MPC.

Association of overall survival benefit of radiotherapy with progression-free survival after chemotherapy for diffuse large B-cell lymphoma: A systematic review and meta-analysis

ObjectiveTo evaluate whether improved progression-free survival (PFS) from radiotherapy (RT) translates into an overall survival (OS) benefit for diffuse large B-cell lymphoma (DLBCL). MethodsA systematic literature search identified randomized controlled trials (RCTs) and retrospective studies that compared combined-modality therapy (CMT) with chemotherapy (CT) alone. Weighted regression analyses were used to estimate the correlation between OS and PFS benefits. Cohen's kappa statistic assessed the consistency between DLBCL risk-models and PFS patterns. Furthermore, the benefit trend of RT was analyzed by fitting a linear regression model to the pooled hazard ratio (HR) according to the PFS patterns. ResultsFor both 7 RCTs and 52 retrospective studies, correlations were found between PFS HR (HRPFS) and OS HR (HROS) at trial level (r = 0.639–0.876), and between PFS and OS rates at treatment-arm level, regardless of CT regimens (r = 0.882–0.964). Incorporating RT into CT increased about 18% of PFS, and revealed a different OS benefit profile. Patients were stratified into four CT-generated PFS patterns (>80%, >60–80%, >40–60%, and ≤40%), which was consistent with risk-stratified subgroups (kappa > 0.6). Absolute gain in OS from RT ranged from ≤5% at PFS >80% to about 21% at PFS ≤40%, with pooled HROS from 0.70 (95% CI, 0.51–0.97) to 0.48 (95% CI, 0.36–0.63) after rituximab-based CT. The OS benefit of RT was predominant in intermediate- and high-risk patients with PFS ≤ 80%. ConclusionWe demonstrated a varied OS benefit profile of RT to inform treatment decisions and clinical trial design.

Survival benefit of radiotherapy and nomogram for patients with primary tracheal malignant tumors: a propensity score-matched SEER database analysis

PurposeThe purpose of this study was to conduct a matched-pair analysis to assess the impact of radiotherapy (RT) on patients with malignant tracheal tumors using the surveillance, epidemiology, and end results database. Additionally, a predictive nomogram was developed for patients with malignant tracheal tumors.MethodsPropensity score matching (PSM) was used to minimize bias between the RT and no-RT groups. We utilized both univariate and multivariate Cox proportional hazards regression analyses to identify independent prognostic factors for patients and subgroups. We developed a novel nomogram and evaluated its results using the C-index.ResultsA total of 648 patients between 1975 and 2019 were included, and 160 patients in RT were 1:1 propensity score-matched with no-RT. The independent prognostic factors for patients with tracheal malignant tumors were surgery, marital status, disease extension, pathology, and age. The independent risk factors for patients without surgery included RT and disease extension. The C-index confirmed that the nomogram accurately predicted the prognosis of patients with tracheal malignant tumors.ConclusionsOur findings suggest that RT may provide a survival benefit for tracheal cancer patients who did not undergo surgery. The nomogram can be a useful tool for predicting prognosis in patients with tracheal malignant tumors.

A propensity score matching study on survival benefits of radiotherapy in patients with inoperable hepatocellular carcinoma

With the advancements in radiotherapy (RT) in recent years, several studies have shown that RT can significantly prolong the survival of patients with hepatocellular carcinoma (HCC). As a noninvasive treatment option, the application of RT for the treatment of HCC is garnering increasing attention. In this retrospective study, we included data from 13,878 patients with HCC from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019 and 325 patients with HCC treated in three tertiary hospitals in China between 2015 and 2021. Patient data were divided into RT and non-RT groups based on whether the patients underwent RT. Propensity score matching analysis was performed to minimize the deviation between the RT and non-RT groups, and the Kaplan–Meier method, Cox proportional hazard model, and nomogram were used to assess the efficacy of undergoing RT. The median overall survival (mOS) of the RT group was significantly longer compared with that of the non-RT group for the SEER data (16 months versus 9 months, p < 0.01). Similarly, the survival benefit was more significant in the RT group than in the non-RT group at our hospitals (34.1 months versus 15.4 months, p < 0.01). Furthermore, multivariate Cox analysis revealed that factors, including tumor (T) stage, patient age, tumor grade, serum AFP level, and chemotherapy, also affected patient survival. Moreover, these factors were also used to construct a nomogram. Subgroup analysis of these factors showed that RT was effective in prolonging patient survival in different populations. RT significantly improves the survival time of patients with inoperable HCC, thereby providing a basis for selecting HCC patients who can benefit from RT.

Survival Benefits of Radiotherapy and Surgery in Lung Cancer Brain Metastases with Poor Prognosis Factors.

Radiotherapy and surgery are the standard local treatments for lung cancer brain metastases (BMs). However, limited studies focused on the effects of radiotherapy and surgery in lung cancer BMs with poor prognosis factors. We retrospectively analyzed 714 patients with lung cancer BMs. Analyses of overall survival (OS) and risk factors for OS were assessed by the log-rank test and Cox proportional hazard model. Age ≥ 65 years, a Karnofsky Performance Scale (KPS) score ≤ 70, anaplastic large-cell lymphoma kinase (ALK)/epidermal growth factor receptor (EGFR) wild type, and extracranial metastases were related to poor prognosis. Patients were stratified according to these poor prognosis factors. In patients with the ALK/EGFR wild type, whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and surgery improved the OS of patients. WBRT and SRS were the independent protective factors for OS. In patients with extracranial metastases, patients who received WBRT plus SRS or WBRT alone had longer OS than those who did not receive radiotherapy. WBRT plus SRS and WBRT were the independent protective factors for OS. Radiotherapy and surgery are associated with improved survival for lung cancer BMs with the ALK/EGFR wild type. Radiotherapy is associated with improved survival in lung cancer BMs with extracranial metastases.

Survival benefit of radiotherapy following narrow-margin hepatectomy in patients with hepatocellular carcinoma: A propensity score-matched analysis based on phase II study

Background and purposeWe evaluated the postoperative radiotherapy (PORT) effects on hepatocellular carcinoma (HCC) prognosis and recurrence in patients who underwent narrow-margin (<1.0 cm) hepatectomy (NH). Materials and methodsThis two-arm cohort study based on the phase II study compared NH with or without PORT in patients with HCC. All patients underwent NH; 76 patients who received PORT following NH in the phase II study were assigned to the NH + RT group, and 171 who underwent NH alone were assigned to the NH group. Propensity score matching (PSM) was used to balance clinicopathological characteristic differences between groups. ResultsBefore PSM, the 5-year overall survival (OS) rates between groups differed significantly (72.2 % vs 60.7 %, P = 0.017). Moreover, the 5-year disease-free survival (DFS) rate was significantly higher in the NH + RT group (51.4 % vs 35.7 %, P = 0.002). After PSM, the between-group difference in OS rates remained high (P = 0.045); the 5-year OS rates were 74.7 % and 63.6 % in the NH + RT and NH groups, respectively. Similarly, the DFS rate remained significantly higher in the NH + RT group (P = 0.001); the 5-year DFS rates were 56.3 % and 31.6 %, respectively. Furthermore, both before and after PSM, patients in the NH + RT group showed significantly lower early, intrahepatic, and extrahepatic recurrence rates than those in the NH group. ConclusionsPORT may have significant OS and DFS benefits in patients with HCC undergoing NH.

Cardiac Adverse Events Associated With Chemo-Radiation Versus Chemotherapy for Resectable Stage III Non-Small-Cell Lung Cancer: A Surveillance, Epidemiology and End Results-Medicare Study.

Background We compared cardiac outcomes for surgery-eligible patients with stage III non-small-cell lung cancer treated adjuvantly or neoadjuvantly with chemotherapy versus chemo-radiation therapy in the Surveillance, Epidemiology and End Results-Medicare database. Methods and Results Patients were age 66+, had stage IIIA/B resectable non-small-cell lung cancer diagnosed between 2007 and 2015, and received adjuvant or neoadjuvant chemotherapy or chemo-radiation within 121 days of diagnosis. Patients having chemo-radiation and chemotherapy only were propensity-score matched and followed from day 121 to first cardiac outcome, noncardiac death, radiation initiation by patients who received chemotherapy only, fee-for-service enrollment interruption, or December 31, 2016. Cause-specific hazard ratios (HRs) and competing risks subdistribution HRs were estimated. The primary outcome was the first of these severe cardiac events: acute myocardial infarction, other hospitalized ischemic heart disease, hospitalized heart failure, percutaneous coronary intervention/coronary artery bypass graft, cardiac death, or urgent/inpatient care for pericardial disease, conduction abnormality, valve disorder, or ischemic heart disease. With median follow-up of 13 months, 70 of 682 patients who received chemo-radiation (10.26%) and 43 of 682 matched patients who received chemotherapy only (6.30%) developed a severe cardiac event (P=0.008) with median time to first event 5.45 months. Chemo-radiation increased the rate of severe cardiac events (cause-specific HR: 1.62 [95% CI, 1.11-2.37] and subdistribution HR: 1.41 [95% CI, 0.97-2.04]). Cancer severity appeared greater among patients who received chemo-radiation (noncardiac death cause-specific HR, 2.53 [95% CI, 1.93-3.33] and subdistribution HR, 2.52 [95% CI, 1.90-3.33]). Conclusions Adding radiation therapy to chemotherapy is associated with an increased risk of severe cardiac events among patients with resectable stage III non-small-cell lung cancer for whom survival benefit of radiation therapy is unclear.

Novel scoring system guiding the incorporation of adjuvant RT for neuroendocrine neoplasms treated with surgical resection followed by chemotherapy.

This study aimed to investigate the role of adjuvant radiotherapy (RT) in neuroendocrine tumors (NET) treated with primary resection and systemic chemotherapy and guide to incorporate adjuvant RT based on individualized prediction. We identified 4324 eligible patients using the SEER database. The most common histology was small cell carcinoma (SCC), followed by neuroendocrine carcinoma and carcinoid tumor. As the patients treated with RT were not randomly assigned, we performed propensity score matching (PSM). RT was administered to 1693 (39.2%) patients who had more unfavorable features [higher proportion of SCC, N2/3 stage, and poorly/undifferentiated (PD) tumors]. After PSM, old age, male sex, SCC, advanced T or N stage, PD tumors, large tumor size, and no use of RT were all significantly associated with a poor prognosis. After multivariate analysis, the survival benefit of RT was preserved (HR 0.82, 95% CI 0.73‒0.91, p < 0.001). Exploratory analysis suggested that primary site, PD tumors, SCC, tumor size < 2cm, or LN negativity were the factors for which adjuvant RT appeared desirable. Further, we proposed a novel scoring system using aforementioned factors; site-thorax/genitourinary, PD tumor, tumor size < 2cm, LN negativity. Based on individually calculated scores, we found that RT significantly increased survival in patients with scores of 2-4 but not in those with scores of 0-1. Our study highlights the necessity of guiding adjuvant RT for these rare types of cancer. We proposed a novel scoring system to carefully recommend RT in selected patients.

P11.75.B Survival benefit of radiotherapy and surgery in patients with lung cancer brain metastases with poor prognosis factors

Abstract Background Radiotherapy and surgery are the standard treatments for lung cancer brain metastases (BMs). However, limitted studies focused on the treatments for patients with lung cancer BMs with poor prognosis factors. The purpose of this study was to investigate the effects of radiotherapy and surgery in patients with lung cancer BMs with poor prognosis factors, providing reference for clinical strategies. Material and Methods We analyzed retrospectively 714 patients with lung cancer BMs. A 1:1 propensity score matching (PSM) was performed to balance potential confounders. Analyses of overall survival (OS) and risk factors for OS were assessed by log-rank test and Cox proportional hazard model. Results Age ≥65 years, Karnofsky Performance Scale (KPS) score ≤70, anaplastic large-cell lymphoma kinase (ALK)/epidermal growth factor receptor (EGFR) wild type, extracranial metastases, non-surgery and non-radiotherapy led to poor prognosis. Patients were stratified according to these factors. Radiotherapy and surgery showed no survival benefit in patients with aged ≥65 years or pretreatment KPS score ≤70 before and after PSM. Before PSM, whole brain radiotherapy (WBRT) improved the OS and predicted good prognosis in patients with ALK/EGFR wild type or extracranial metastases. WBRT also predicted good prognosis in patients with non-surgery. Stereotactic radiosurgery (SRS) improved the OS and predicted good prognosis in patients with ALK/EGFR wild type or non-surgery. WBRT plus SRS improved the OS and predicted good prognosis in patients with extracranial metastases or non-surgery. WBRT plus SRS also predicted good prognosis in patients with ALK/EGFR wild type. Surgery improved the OS and predicted good prognosis in patients with non-radiotherapy. After PSM, SRS improved the OS and predicted good prognosis in patients with non-surgery. WBRT plus SRS improved the OS and predicted good prognosis in patients with non-surgery or extracranial metastases. WBRT plus SRS also predicted good prognosis in patients with ALK/EGFR wild type. Surgery improved the OS of patients with non-radiotherapy. We defined that the treatment would provide significant survival benefit if it both prolonged the OS and predicted good prognosis. Meanwhile, the results after PSM were more convincing than the results before PSM. Conclusion Radiotherapy has significant survival benefit in patients with lung cancer BMs with poor prognosis factors, including patients with ALK/EGFR wild type or extracranial metastases or non-surgery. Surgery only has significant survival benefit in patients with non-radiotherapy.

Is There a Role for Perioperative Radiotherapy in Surgically Resected Stage IV Rectal Cancer? A Propensity Score Matched Analysis

This study aimed to determine whether perioperative radiotherapy (RT) improves outcomes in stage IV rectal cancer patients treated with primary surgical resection and systemic chemotherapy and to identify predictive factors for selection of patients for these approaches.We searched the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed between 2010 and 2015 with stage IV rectal cancer, but without brain or bone metastases. After applying the exclusion criteria, a total of 26,132 patients were included in the analysis; propensity score matching was used to balance their individual characteristics.Overall, 3283 (12.6%) patients received perioperative RT; the 3-year overall survival (OS) rates were 43.6% in the surgery group and 50.5% in the surgery with RT group (P < 0.001). The survival benefit of RT was maintained after propensity score matching and multivariate adjustment (HR 0.70, 95% CI, 0.66-0.81, P < 0.001). Interaction testing of the prognostic variables revealed a significant interaction between RT and the presence of lung metastasis (P < 0.001): the benefit of RT was observed only in patients without lung metastases (3-year OS 52.1% vs. 44.1%, P < 0.001), but it was observed regardless of liver metastases. Additionally, we developed a web-based calculator (http://bit.do/mRC_surv) to provide individualized estimates of OS benefit based on the receipt of perioperative RT.Perioperative RT significantly improved OS rates, especially in patients without lung metastases. We successfully developed a nomogram and web-based calculator that could predict survival benefit with the addition of RT for these patients.

A Prognostic Ferroptosis-Related lncRNAs Signature Associated With Immune Landscape and Radiotherapy Response in Glioma.

Recent studies have demonstrated that long non-coding RNAs (lncRNAs) are implicated in the regulation of tumor cell ferroptosis. However, the prognostic value of ferroptosis-related lncRNAs has never been comprehensively explored in glioma. In this study, the transcriptomic data and clinical information of glioma patients were downloaded from TCGA, CGGA and Rembrandt databases. We identified 24 prognostic ferroptosis-related lncRNAs, 15 of which (SNAI3-AS1, GDNF-AS1, WDFY3-AS2, CPB2-AS1, WAC-AS1, SLC25A21-AS1, ARHGEF26-AS1, LINC00641, LINC00844, MIR155HG, MIR22HG, PVT1, SNHG18, PAXIP1-AS2, and SBF2-AS1) were used to construct a ferroptosis-related lncRNAs signature (FRLS) according to the least absolute shrinkage and selection operator (LASSO) regression. The validity of this FRLS was verified in training (TCGA) and validation (CGGA and Rembrandt) cohorts, respectively. The Kaplan-Meier curves revealed a significant distinction of overall survival (OS) between the high- and low-risk groups. The receiver operating characteristic (ROC) curves exhibited robust prognostic capacity of this FRLS. A nomogram with improved accuracy for predicting OS was established based on independent prognostic factors (FRLS, age, and WHO grade). Besides, patients in the high-risk group had higher immune, stroma, and ESTIMATE scores, lower tumor purity, higher infiltration of immunosuppressive cells, and higher expression of immune checkpoints. Patients in the low-risk group benefited significantly from radiotherapy, while no survival benefit of radiotherapy was observed for those in the high-risk group. In conclusion, we identified the prognostic ferroptosis-related lncRNAs in glioma, and constructed a prognostic signature which was associated with the immune landscape of glioma microenvironment and radiotherapy response.

Is There a Role for Perioperative Pelvic Radiotherapy in Surgically Resected Stage IV Rectal Cancer?: A Propensity Score-matched Analysis.

This study aimed to determine whether perioperative pelvic radiotherapy (RT) improves outcomes in stage IV rectal cancer patients treated with primary surgical resection and systemic chemotherapy and to identify predictive factors for selection of patients for these approaches. We searched the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed between 2010 and 2015 with stage IV rectal cancer, but without brain or bone metastases. After applying the exclusion criteria, a total of 26,132 patients were included in the analysis; propensity score matching was used to balance their individual characteristics. Overall, 3283 (12.6%) patients received perioperative RT; the 3-year overall survival (OS) rates were 43.6% in the surgery group and 50.5% in the surgery with RT group (P<0.001). The survival benefit of RT was maintained after propensity score matching and multivariate adjustment (hazard ratio: 0.70; 95% confidence interval: 0.66-0.81; P<0.001). Interaction testing of the prognostic variables showed a significant interaction between RT and the presence of lung metastasis (P<0.001): the benefit of RT was observed only in patients without lung metastases (3 y OS 52.1% vs. 44.1%, P<0.001), but it was observed regardless of liver metastases. In addition, we developed a web-based calculator (http://bit.do/mRC_surv) to provide individualized estimates of OS benefit based on the receipt of perioperative pelvic RT. Perioperative pelvic RT significantly improved OS rates, especially in patients without lung metastases. We successfully developed a nomogram and web-based calculator that could predict survival benefit with the addition of RT for these patients.

Chemotherapy Plus Radiotherapy Versus Chemotherapy Alone for Patients With Peripheral T-Cell Lymphoma, Not Otherwise Specified.

PurposePeripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is a clinically and biologically heterogeneous disease with poor prognosis. As the role of radiation therapy (RT) is still unclear, we carried out this study to evaluate the potential efficacy of RT in PTCL-NOS.MethodsPatients diagnosed with PTCL-NOS between 2000 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching was used to balance the characteristics between patients who received radiotherapy and those who did not receive radiotherapy. In addition, we validated the findings in an external validation cohort retrospectively recruited from two high-capacity cancer center in China between 2006 and 2016. Kaplan-Meier curves and Cox regression models were used for survival analysis.ResultsOf the 2,768 patients with chemotherapy records in the SEER cohort, 27.6% of 844 patients with early-stage disease and 6.8% of 1,924 patients with advanced-stage disease received RT. The application of RT was significantly associated with an improvement in overall survival (5-year OS rate 58.5 versus 35.1%, P <0.001) and disease-specific survival (5-year DSS rate 66.3 versus 44.0%, P <0.001) in the early-stage subgroup, while no apparent survival benefit of adding RT was identified in patients with advanced-stage disease (5-year OS rate 28.7 versus 24.4%, P = 0.089; 5-year DSS rate 32.9 versus 31.3%, P = 0.223). After adjustment, a matched cohort of 1,044 patients (348 in the RT combined with CT group and 696 in the CT alone group) was created. And RT was still significantly associated with a survival benefit in the early-stage subset, but not in the advanced-stage disease group. In the validation cohort with more comprehensive data, RT also significantly improved the survival of early-stage PTCL-NOS patients.ConclusionAdding RT was associated with significant improvement in survival in early-stage PTCL-NOS, but the survival benefit of RT was not obvious in advanced-stage disease. The incorporation of RT for treatment in early-stage PTCL-NOS should be highly considered. Further prospective studies with more comprehensive data are needed to evaluate the effectiveness and toxicity of RT in PTCL-NOS.

The Role of Postoperative Radiotherapy and Prognostic Model in Primary Squamous Cell Carcinoma of Parotid Gland.

BackgroundPrimary squamous cell carcinoma of parotid gland (parotid SCC) is a high malignant histologic subtype of parotid cancers with aggressive clinical presentation. However, the clinical features and survival benefit of postoperative radiotherapy (PORT) for primary parotid SCC are not well known.MethodsA retrospective population-based study was performed to identify the role of PORT in parotid SCC patients diagnosed between 1975 and 2016 from SEER database. A prognostic risk model was established based on patient clinical features, including age, tumor stage, and node involvement status. Patients were stratified into high, intermediate, and low risk according to this model. The survival benefit of radiotherapy was compared in the whole cohort and different risk groups.ResultsNine hundred thirty-one parotid SCC patients were extracted from SEER database, 634 (68.1%) in the RT group and 286 (30.7%) in the non-RT group. Overall, 503 (54.0%) deaths occurred, with a median follow-up of 84 months, the 5-year OS was 43.6% in the whole cohort, 47.7 vs 35.9% in patients with/without PORT (P = 0.005), and 58.9 vs. 38.8 vs. 27.1% in low-, intermediate-, and high-risk group (P < 0.001). Compared with surgery alone, PORT significantly improved the OS of patients with medium risk (47.5 vs. 20.6, P < 0.001), whereas not in the low risk (61 vs. 54%, P = 0.710) and high (25.6 vs. 28.7%, P = 0.524).ConclusionThis prognostic model can separate the patients with parotid squamous cell carcinoma into different risk. PORT significantly improved the OS of patients with intermediate risk, whereas high-risk group may need more intensive treatment strategies.

Intensity-Modulated Radiation Therapy May Improve Survival and Local Tumor Control in Resected Tracheo-Bronchial Adenoid Cystic Carcinoma: A Retrospective Study of 65 Cases

The evidence about survival benefit of radiation therapy (RT) in resected tracheo-bronchial adenoid cystic carcinoma (TACC) is limited. Advanced intensity-modulated radiation therapy (IMRT) technique could improve tumor dose conformality and reduce normal tissue exposure, which would result in a higher rate of local control and a longer survival time compared with conventional RT. This study aimed to evaluate the impact of postoperative IMRT on survival of TACC patients. Patients with TACC treated with surgery and adjuvant radiotherapy in our institution between 1976 and 2016 were retrospectively reviewed. The adjuvant RT was given when the margin was positive or the tumor was close to the resection margin. Patients were dichotomized into IMRT or non-IMRT group. The overall survival (OS), loco-regional recurrence free survival (LRFS), and distant metastasis free survival (DMFS) were calculated from the date of diagnosis. Cox regression was used to identify factors associated with survival and adjust for covariates (P value <0.1 in the univariate analysis). A total of 65 patients were eligible, including 30 with IMRT and 35 with non-IMRT. Patients in the IMRT group had a higher proportion of pathologic N1 stage (30.0% vs. 8.6%, P = 0.058). Other baseline characters (age, sex, tumor location, T stage (T1-2 vs. T3-4), and Charlson/Deyo comorbidity score) were well balanced. The 5- and 10-year OS of the IMRT group were 89.4% (95%CI: 70.6%-96.5%) and 83.9% (95%CI: 61.4%-93.8%), which were significantly superior to those of the non-IMRT group (78.2 % [95%CI: 59.4%-89.0%] and 50.3 % [95%CI: 30.2%-67.4%]; P = 0.031). IMRT was associated with significantly improved 5- and 10-year LRFS in comparison with non-IMRT (5-year: 96.3% [95%CI: 76.5%-99.5%] vs. 68.7% [95%CI: 49.4%-81.9%]; 10-year: 89.9% [95%CI: 63.6%-97.5%] vs. 44.4% [95%CI: 22.4%-64.3%]; P = 0.002). Only 2 of 30 patients (6.6%) developed loco-regional recurrence after IMRT, whereas 14 of 35 (40.0%) failed locally in the non-IMRT group. No difference in DMFS was observed between IMRT and non-IMRT groups (P = 0.680). There were no statistical differences in OS as for RT dose or adjuvant chemotherapy. Multivariable analysis identified IMRT as an independent favorable factor of OS (HR = 0.31, 95% CI: 0.11-0.85, P = 0.022) and LRFS (HR = 0.18, 95% CI: 0.04-0.81, P = 0.025) after adjusting for T stage (P = 0.100 on univariable analysis) and tumor size (P = 0.033). IMRT was an effective treatment which might confer superior local control and survival benefit in the setting of postoperative TACC.

The survival benefit of radiotherapy in localized primary adult rhabdomyosarcoma.

To evaluate the role of radiotherapy (RT) in the treatment of localized primary adult rhabdomyosarcoma (RMS). This retrospective study identified 62 consecutive adult patients with localized primary RMS from January 2000 and July 2016. Local failure-free survival (LFFS), distant metastasis-free survival (DMFS) and overall survival (OS) were analyzed by the Kaplan-Meier method. Multivariate Cox proportional hazards regression models were fit to assess the ability of patient characteristics to predict survival. With a median follow-up of 33 months (range, 6-195 months), the 5-year LFFS, DMFS and OS of all patients were 64.0%, 50.0% and 45.0%, respectively. RT was administered to 28 patients (45.2%). Patients who received RT had a higher 5-year LFFS (81.7% vs 47.2%), 5-year DMFS (59.4% vs 43.1%) and 5-year OS (57.1% vs 34.8%) compared with patients who did not received RT. In mulitvariate analysis, RT retained significance as an independent predictor of improved LFFS [hazard ratio (HR)=0.282; 95% confidence interval (CI), 0.095-0.838; P=0.023], DMFS (HR=0.289; 95% CI, 0.125-0.991; P=0.004) and OS (HR=0.334; 95% CI, 0.153-0.727; P=0.006). RT significantly reduced local recurrence, distant metastasis and tumor mortality compared with no radiotherapy for localized primary adult RMS.

The Survival Benefit From the Addition of Radiation to Chemotherapy in Gastric Cancer Patients Following Surgical Resection

AimsThe survival benefit of radiation therapy in gastric cancer patients who underwent curative resection remains contentious. Materials and methodsGastric cancer patients who underwent curative resection followed by adjuvant chemotherapy or chemoradiation therapy (CRT) between 2004 and 2014 were identified from the National Cancer Database. Survival analyses were carried out with the Kaplan–Meier method and the Cox regression model. ResultsIn total, 4347 patients were included in this study. Of these patients, 1185 patients received postoperative chemotherapy alone and 3162 patients received postoperative CRT. For all patients included in the analysis, patients who received CRT had significantly better overall survival than those who received chemotherapy alone (5-year overall survival: 54.8% versus 46.8%, P < 0.001). The survival benefit primarily occurred in patients with stage II (5-year overall survival: 58.7% versus 53.8%, P = 0.03), stage III (42.5% versus 30.3%, P < 0.001) and lymph node-positive (5-year overall survival: 52.2% versus 41.9%, P = 0.03) gastric cancer. Multivariable analysis confirmed the improvement in overall survival in patients who received postoperative CRT (hazard ratio = 0.78; 95% confidence interval, 0.661–0.926; P < 0.001) was independent of all known prognostic factors. For lymph node-positive patients with lymphovascular invasion (LVI), postoperative CRT significantly improved overall survival compared with chemotherapy alone (5-year overall survival: 49.0% versus 39.4%, P = 0.001). However, there was no survival difference between CRT and chemotherapy alone if lymph node-positive patients had no LVI (5-year overall survival: 54.5% versus 52.7%, P = 0.55). ConclusionThe current study suggests that postoperative CRT provides a survival benefit in gastric cancer patients with concurrent lymph node-positive and LVI-positive disease. A randomised clinical trial may further evaluate the benefit of adjuvant CRT in this subgroup.

Analysis of Real World Data To Evaluate Survival Benefit of Radiation Therapy in Stage III / N2 Non-Small Cell Lung Cancer

The clinical benefit of radiation therapy for patients with locally advanced stage III (N2) Non-Small Cell Lung Cancer (NSCLC) treated with surgery remains unclear due to a paucity of level 1 evidence. This study examined real-world evidence using a cohort of NSCLC patients from a multi-institution dataset to evaluate outcomes in patient treated with surgery alone, neoadjuvant or adjuvant radiation therapy. We extracted a sample of 415 fully-abstracted patients with pathologic stage III (N2) NSCLC defined at the initial surgical intervention performed within 6 months of initial diagnosis. Two- and five-year survival outcomes were evaluated for patients who received radiation neoadjuvant, adjuvant (PORT), or no radiation therapy. Sub-analyses and normalization of treatment groups were performed including use of chemotherapy, targeted therapy and IO therapy as well as age and gender using Cox proportionate hazards. Of the 415 patients evaluated, 54% (n=206) were treated with surgery alone, 16% (n=66) neoadjuvant radiation therapy and 34% (n=143) adjuvant radiation therapy. Chemotherapy use for patients across groups was balanced, 68% (n=140), 83% (n=56), 72% (n=103) for patient treated with surgery, neoadjuvant or adjuvant radiation therapy, respectively. Patients who received neoadjuvant radiation therapy had a 45% reduction in 2-year mortality risk (HR = .55, 95% CI 0.35 - 0.89), compared to patients treated with surgery alone (HR = 0.59, 95% CI .37 - 0.93). Radiation therapy did not improve 5-year mortality risk except in female patients, who show a 48% reduction in mortality risk at 5-years from radiation therapy pre- or post-operatively (HR = .52, 95% CI .29 - .94). There was no statistically significant difference in survival outcomes for patients treated with adjuvant radiation therapy, compared to surgery alone. Analysis of 415 abstracted patients this dataset suggests that the addition of preoperative radiation therapy improves 2 and 5-year survival for patients with pathologic stage III (N2) NSCLC, compared to patients treated with surgery alone. A significant survival benefit was not observed for adjuvant radiation therapy, however surgical margin status, performance status, and incidence of comorbidities was not included in the analysis due to the lack of granularity of the retrospective data.Abstract 3222; Table 1Surgery Only / No Radiation TherapyNeoadjuvant Radiation TherapyAdjuvant Radiation TherapyAll PatientsTotal (n)2-Year OS5-year OSTotal (n)2-Year OS5-Year OSTotal(n)2-Year OS5-Year OSTotal (n)2-Year OS5-Year OSAll patients20677%67%6692%86%14384%76%41582%71%Age >= 6015177%66%4994%78%10083%75%30082%71%Age < 605578%67%1712%71%4386%77%11583%71%Male10977%64%3090%70%7077%66%20979%66%Female9777%69%3694%81%7390%85%20685%77%Chemotherapy14076%74%5591%73%10380%70%29880%68%Neoadjuvant chemotherapy3093%87%4489%76%1090%80%8590%81%No chemotherapy6680%71%11100%91%4095%90%11787%79% Open table in a new tab

Survival benefit of radiotherapy in metastatic esophageal cancer: a population-based study

Background: Population-based estimates of survival benefits of radiotherapy on metastatic esophageal cancer (EC) are lacking. The aim of this study was to analyze survival benefits of radiotherapy in patients with metastatic EC at the time of cancer diagnosis. Methods: Patients with metastatic EC were selected from Surveillance, Epidemiology, and End Results databases. The covariates included radiotherapy status, age, sex, insurance, histological type, differentiation, metastatic sites (bone, brain, liver, lung), and chemotherapy. Propensity score matching model was used to reduce bias of patients’ selection. Median overall survival (OS) and cancer-specific survival (CSS) were compared and Cox regression analysis was performed. Results: A total of 4,761 patients with metastatic EC met the selection criteria. It was found that radiotherapy significantly improved 2-year OS (P=0.020) and 2-year CSS (P=0.009) in matched patients. In the propensity score model (N=3,672), Cox regression analysis demonstrated that radiotherapy was an independent prognostic factor which associated with a longer OS (P Conclusions: The population-based study demonstrated that patients with metastatic EC might benefit from radiotherapy. This data supports the proposal to change the current management for patients with metastatic EC.

Abstract P3-12-23: Utilization and survival benefit of radiation therapy among hormone receptor positive breast cancer patients with recurrence score from Oncotype DX testing

Abstract Background: Radiation therapy (RT) improves survival of breast cancer (BC) patients receiving the lumpectomy. Oncotype DX, a 21-gene Recurrence Score (RS) assay, has been validated to predict the risk of recurrence and chemotherapy benefit for hormone receptor positive (HR+) BC without metastatic lymph nodes (PN0). With increasing use of Oncotype DX, it is unclear if the utilization and survival benefit of RT vary by RS in clinical practice. This study aimed to 1) examine if the RS from Oncotype DX testing influences RT utilization among HR+ BC patients with PN0 who received lumpectomy; and 2) investigate if RT is associated with better cause-specific survival (CSS) and overall survival (OS) among patients stratified by the low, intermediate, and high RS. Methods: Data from Genomic Health Inc., the sole Oncotype DX testing provider in the U.S., was linked with routinely collected data from 17 SEER registries. Women who were diagnosed with PN0 and HR+ BC in 2004-2015, received the lumpectomy, and had RS from Oncotype DX testing were included. Patients who had multiple tumors, received RT before or within surgery, or had less than 2 months follow-up were excluded. Patients diagnosed in 2004-2014 and followed through the end of 2015 were included in the survival analysis. RS was categorized into low (&amp;lt;18), intermediate (18-30), and high (&amp;gt;30). RT was categorized into yes, no or unknown. Multivariable logistic regression was applied to examine the association between RS and RT utilization. To compare survival differences, patients receiving RT and patients having no or unknown RT were matched on propensity score, which was calculated based on diagnosis year, age, race, marital status, tumor size, grade, number of lymph nodes examined, chemotherapy, and participating state. Stratified Cox proportional hazards models were used to compare CSS and OS between two matched groups. Proportional hazard assumption was evaluated. Results: Out of 48,615 patients, 56.8% had low, 36.1% had intermediate, and 7.1% had high RS; 84.5% received RT (86.6%, 82.8%, and 76.4% in low, intermediate, and high RS patients, respectively; P &amp;lt; 0.0001). After adjusting for covariates, patients with intermediate (odds ratio [OR] 0.75; 95% CI 0.71-0.79; P &amp;lt; 0.0001) and high RS (OR 0.53; 95% CI 0.47-0.59; P &amp;lt; 0.0001) were less likely to receive RT than patients with low RS. Among patients with low or intermediate RS, having no or unknown RT was associated with worse CSS (low RS: hazard ratio [HR] 6.00, 95% CI 1.77-20.37, P = 0.004; intermediate RS: HR 2.12, 95% CI 1.19-3.77, P = 0.01) and OS (low RS: HR 2.29, 95% CI 1.56-3.35, P &amp;lt; 0.0001; intermediate RS: HR 2.22, 95% CI: 1.54-3.21, P &amp;lt; 0.0001). RT utilization was not significantly associated with CSS or OS among patients with high RS. Conclusions: Among HR+, PN0 BC patients receiving the lumpectomy, lower RS was associated with higher RT utilization. RT was associated with better CSS and OS among patients with low or intermediate RS. Among patients with high RS, no association between RT and survival was observed. Citation Format: Zhang L, Hsieh M-C, Petkov VI, Wu X-C, Yu Q. Utilization and survival benefit of radiation therapy among hormone receptor positive breast cancer patients with recurrence score from Oncotype DX testing [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-23.