Steven H Lin1, Kenneth W Merrell2, Jincheng Shen3, Vivek Verma4, Arlene M Correa5, Lu Wang6, Peter F Thall7, Neha Bhooshan8, Sarah E James2, Michael G Haddock2, Mohan Suntharalingam8, Minesh P Mehta9, Zhongxing Liao10, James D Cox10, Ritsuko Komaki10, Reza J Mehran5, Michael D Chuong11, Christopher L Hallemeier12. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. Electronic address: shlin@mdanderson.org. 2. Department of Radiation Oncology, Mayo Clinic, Rochester, United States. 3. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, United States. 4. Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, United States. 5. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, United States. 6. Department of Biostatistics, University of Michigan, Ann Arbor, United States. 7. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, United States. 8. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, United States. 9. Department of Radiation Oncology, Miami Cancer Institute, Miami, United States. 10. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. 11. Department of Radiation Oncology, Miami Cancer Institute, Miami, United States. Electronic address: mchuong@umm.edu. 12. Department of Radiation Oncology, Mayo Clinic, Rochester, United States. Electronic address: hallemeier.christopher@mayo.edu.
Abstract
PURPOSE: Relative radiation dose exposure to vital organs in the thorax could influence clinical outcomes in esophageal cancer (EC). We assessed whether the type of radiation therapy (RT) modality used was associated with postoperative outcomes after neoadjuvant chemoradiation (nCRT). PATIENTS AND METHODS: Contemporary data from 580 EC patients treated with nCRT at 3 academic institutions from 2007 to 2013 were reviewed. 3D conformal RT (3D), intensity modulated RT (IMRT) and proton beam therapy (PBT) were used for 214 (37%), 255 (44%), and 111 (19%) patients, respectively. Postoperative outcomes included pulmonary, GI, cardiac, wound healing complications, length of in-hospital stay (LOS), and 90-day postoperative mortality. Cox model fits, and log-rank tests both with and without Inverse Probability of treatment Weighting (IPW) were used to correct for bias due to non-randomization. RESULTS: RT modality was significantly associated with the incidence of pulmonary, cardiac and wound complications, which also bore out on multivariate analysis. Mean LOS was also significantly associated with treatment modality (13.2days for 3D (95%CI 11.7-14.7), 11.6days for IMRT (95%CI 10.9-12.7), and 9.3days for PBT (95%CI 8.2-10.3) (p<0.0001)). The 90day postoperative mortality rates were 4.2%, 4.3%, and 0.9%, respectively, for 3D, IMRT and PBT (p=0.264). CONCLUSIONS: Advanced RT technologies (IMRT and PBT) were associated with significantly reduced rate of postoperative complications and LOS compared to 3D, with PBT displaying the greatest benefit in a number of clinical endpoints. Ongoing prospective randomized trial will be needed to validate these results.
PURPOSE: Relative radiation dose exposure to vital organs in the thorax could influence clinical outcomes in esophageal cancer (EC). We assessed whether the type of radiation therapy (RT) modality used was associated with postoperative outcomes after neoadjuvant chemoradiation (nCRT). PATIENTS AND METHODS: Contemporary data from 580 EC patients treated with nCRT at 3 academic institutions from 2007 to 2013 were reviewed. 3D conformal RT (3D), intensity modulated RT (IMRT) and proton beam therapy (PBT) were used for 214 (37%), 255 (44%), and 111 (19%) patients, respectively. Postoperative outcomes included pulmonary, GI, cardiac, wound healing complications, length of in-hospital stay (LOS), and 90-day postoperative mortality. Cox model fits, and log-rank tests both with and without Inverse Probability of treatment Weighting (IPW) were used to correct for bias due to non-randomization. RESULTS: RT modality was significantly associated with the incidence of pulmonary, cardiac and wound complications, which also bore out on multivariate analysis. Mean LOS was also significantly associated with treatment modality (13.2days for 3D (95%CI 11.7-14.7), 11.6days for IMRT (95%CI 10.9-12.7), and 9.3days for PBT (95%CI 8.2-10.3) (p<0.0001)). The 90day postoperative mortality rates were 4.2%, 4.3%, and 0.9%, respectively, for 3D, IMRT and PBT (p=0.264). CONCLUSIONS: Advanced RT technologies (IMRT and PBT) were associated with significantly reduced rate of postoperative complications and LOS compared to 3D, with PBT displaying the greatest benefit in a number of clinical endpoints. Ongoing prospective randomized trial will be needed to validate these results.
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