Anna Lee1,2, Ashley Albert3, Niki Sheth1,2, Paul Adedoyin1,2, Jared Rowley1,2, David Schreiber1,4. 1. Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA. 2. Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA. 3. Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA. 4. Summit Medical Group MD Anderson Cancer Center, Berkeley Heights, NJ, USA.
Abstract
BACKGROUND: Definitive chemoradiation is the standard of care for anal squamous cell carcinoma. Compared to three-dimensional conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT) is increasingly becoming the preferred technique in order to reduce treatment related toxicity. The objective of this study is to evaluate practice patterns and total radiation treatment times of two radiation modalities. METHODS: A total of 6,966 patients with non-metastatic squamous cell carcinoma of the anus who received definitive chemoradiation were queried from the National Cancer Database (NCDB) from 2004-2013. Logistic regression was performed to assess for predictors of IMRT receipt. The Kaplan-Meier method and multivariable Cox regression analysis was used to assess overall survival (OS). RESULTS: In total, 3,868 (55.5%) received 3DCRT and 3,098 (44.5%) received IMRT. Total radiation treatment time was <7 weeks for 54.3% of patients treated with 3DCRT versus 63.8% of patients treated with IMRT. On multivariable logistic regression, positive clinical nodes (OR =1.20, P=0.001) and treatment at an academic facility (OR =1.23, P<0.001) were associated with increased likelihood of receiving IMRT. The 5-year OS was 73.0% for 3DCRT and 73.9% for IMRT (P=0.315). On multivariable analysis, total radiation treatment time ≥7 weeks (HR =1.33, P<0.001) was associated with worse survival while radiation modality (3DCRT vs. IMRT) did not impact survival (HR =0.98, P=0.763). CONCLUSIONS: IMRT has dramatically increased in utilization from 2% to 65% during the study time period. IMRT was less likely than 3DCRT to have prolonged radiation treatment times, which was associated with worse survival.
BACKGROUND: Definitive chemoradiation is the standard of care for anal squamous cell carcinoma. Compared to three-dimensional conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT) is increasingly becoming the preferred technique in order to reduce treatment related toxicity. The objective of this study is to evaluate practice patterns and total radiation treatment times of two radiation modalities. METHODS: A total of 6,966 patients with non-metastatic squamous cell carcinoma of the anus who received definitive chemoradiation were queried from the National Cancer Database (NCDB) from 2004-2013. Logistic regression was performed to assess for predictors of IMRT receipt. The Kaplan-Meier method and multivariable Cox regression analysis was used to assess overall survival (OS). RESULTS: In total, 3,868 (55.5%) received 3DCRT and 3,098 (44.5%) received IMRT. Total radiation treatment time was <7 weeks for 54.3% of patients treated with 3DCRT versus 63.8% of patients treated with IMRT. On multivariable logistic regression, positive clinical nodes (OR =1.20, P=0.001) and treatment at an academic facility (OR =1.23, P<0.001) were associated with increased likelihood of receiving IMRT. The 5-year OS was 73.0% for 3DCRT and 73.9% for IMRT (P=0.315). On multivariable analysis, total radiation treatment time ≥7 weeks (HR =1.33, P<0.001) was associated with worse survival while radiation modality (3DCRT vs. IMRT) did not impact survival (HR =0.98, P=0.763). CONCLUSIONS: IMRT has dramatically increased in utilization from 2% to 65% during the study time period. IMRT was less likely than 3DCRT to have prolonged radiation treatment times, which was associated with worse survival.
Entities:
Keywords:
Definitive chemoradiation; anal carcinoma; intensity modulated radiation therapy (IMRT); three-dimensional conformal radiation therapy (3DCRT); total treatment time
Authors: Lisa A Kachnic; Henry K Tsai; John J Coen; Lawrence S Blaszkowsky; Kevan Hartshorn; Eunice L Kwak; John D Willins; David P Ryan; Theodore S Hong Journal: Int J Radiat Oncol Biol Phys Date: 2010-11-20 Impact factor: 7.038
Authors: Jose G Bazan; Wendy Hara; Annie Hsu; Pamela A Kunz; James Ford; George A Fisher; Mark L Welton; Andrew Shelton; Daniel S Kapp; Albert C Koong; Karyn A Goodman; Daniel T Chang Journal: Cancer Date: 2011-02-01 Impact factor: 6.860
Authors: J H Kim; B Sarani; B A Orkin; H A Young; J White; I Tannebaum; S Stein; B Bennett Journal: Dis Colon Rectum Date: 2001-10 Impact factor: 4.585
Authors: Joseph M Pepek; Christopher G Willett; Q Jackie Wu; Sua Yoo; Robert W Clough; Brian G Czito Journal: Int J Radiat Oncol Biol Phys Date: 2010-03-16 Impact factor: 7.038
Authors: Edgar Ben-Josef; Jennifer Moughan; Jaffer A Ajani; Marshall Flam; Leonard Gunderson; JonDavid Pollock; Robert Myerson; Rani Anne; Seth A Rosenthal; Christopher Willett Journal: J Clin Oncol Date: 2010-10-18 Impact factor: 44.544
Authors: J Northover; R Glynne-Jones; D Sebag-Montefiore; R James; H Meadows; S Wan; M Jitlal; J Ledermann Journal: Br J Cancer Date: 2010-03-16 Impact factor: 7.640
Authors: Joseph K Salama; Loren K Mell; David A Schomas; Robert C Miller; Kiran Devisetty; Ashesh B Jani; Arno J Mundt; John C Roeske; Stanley L Liauw; Steven J Chmura Journal: J Clin Oncol Date: 2007-10-10 Impact factor: 44.544
Authors: Ramin Roohipour; Sujata Patil; Karyn A Goodman; Bruce D Minsky; W Douglas Wong; José G Guillem; Philip B Paty; Martin R Weiser; Heather B Neuman; Jinru Shia; Deborah Schrag; Larissa K F Temple Journal: Dis Colon Rectum Date: 2008-01-08 Impact factor: 4.585
Authors: Ahmed Allam Mohamed; Marsha Schlenter; Alexander Heinzel; Svetlana Kintsler; Michael J Eble Journal: Front Oncol Date: 2022-05-26 Impact factor: 5.738