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Title: Adjuvant Radiation Therapy Treatment Time Impacts Overall Survival in Gastric Cancer

Abstract

Purpose: Prolonged radiation therapy treatment time (RTT) is associated with worse survival in several tumor types. This study investigated whether delays during adjuvant radiation therapy impact overall survival (OS) in gastric cancer. Methods and Materials: The National Cancer Data Base was queried for patients with resected gastric cancer who received adjuvant radiation therapy with National Comprehensive Cancer Network–recommended doses (45 or 50.4 Gy) between 1998 and 2006. RTT was classified as standard (45 Gy: 33-36 days, 50.4 Gy: 38-41 days) or prolonged (45 Gy: >36 days, 50.4 Gy: >41 days). Cox proportional hazards models evaluated the association between the following factors and OS: RTT, interval from surgery to radiation therapy initiation, interval from surgery to radiation therapy completion, radiation therapy dose, demographic/pathologic and operative factors, and other elements of adjuvant multimodality therapy. Results: Of 1591 patients, RTT was delayed in 732 (46%). Factors associated with prolonged RTT were non-private health insurance (OR 1.3, P=.005) and treatment at non-academic facilities (OR 1.2, P=.045). Median OS and 5-year actuarial survival were significantly worse in patients with prolonged RTT compared with standard RTT (36 vs 51 months, P=.001; 39 vs 47%, P=.005); OS worsened with each cumulative week of delay (P<.0004). On multivariable analysis, prolonged RTT was associated with inferior OS (hazard ratiomore » 1.2, P=.002); the intervals from surgery to radiation therapy initiation or completion were not. Prolonged RTT was particularly detrimental in patients with node positivity, inadequate nodal staging (<15 nodes examined), and those undergoing a cycle of chemotherapy before chemoradiation therapy. Conclusions: Delays during adjuvant radiation therapy appear to negatively impact survival in gastric cancer. Efforts to minimize cumulative interruptions to <7 days should be considered.« less

Authors:
 [1];  [2];  [1];  [3]; ;  [1];  [4]; ; ;  [3]; ;  [1];  [3]
  1. Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States)
  2. (United States)
  3. Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States)
  4. Department of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States)
Publication Date:
OSTI Identifier:
22458779
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 93; Journal Issue: 2; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEMOTHERAPY; COMPARATIVE EVALUATIONS; HAZARDS; INSURANCE; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SURGERY

Citation Formats

McMillan, Matthew T., Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Ojerholm, Eric, Roses, Robert E., E-mail: Robert.Roses@uphs.upenn.edu, Plastaras, John P., Metz, James M., Mamtani, Ronac, Karakousis, Giorgos C., Fraker, Douglas L., Drebin, Jeffrey A., Stripp, Diana, Ben-Josef, Edgar, and Datta, Jashodeep. Adjuvant Radiation Therapy Treatment Time Impacts Overall Survival in Gastric Cancer. United States: N. p., 2015. Web. doi:10.1016/J.IJROBP.2015.05.025.
McMillan, Matthew T., Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Ojerholm, Eric, Roses, Robert E., E-mail: Robert.Roses@uphs.upenn.edu, Plastaras, John P., Metz, James M., Mamtani, Ronac, Karakousis, Giorgos C., Fraker, Douglas L., Drebin, Jeffrey A., Stripp, Diana, Ben-Josef, Edgar, & Datta, Jashodeep. Adjuvant Radiation Therapy Treatment Time Impacts Overall Survival in Gastric Cancer. United States. doi:10.1016/J.IJROBP.2015.05.025.
McMillan, Matthew T., Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Ojerholm, Eric, Roses, Robert E., E-mail: Robert.Roses@uphs.upenn.edu, Plastaras, John P., Metz, James M., Mamtani, Ronac, Karakousis, Giorgos C., Fraker, Douglas L., Drebin, Jeffrey A., Stripp, Diana, Ben-Josef, Edgar, and Datta, Jashodeep. Thu . "Adjuvant Radiation Therapy Treatment Time Impacts Overall Survival in Gastric Cancer". United States. doi:10.1016/J.IJROBP.2015.05.025.
@article{osti_22458779,
title = {Adjuvant Radiation Therapy Treatment Time Impacts Overall Survival in Gastric Cancer},
author = {McMillan, Matthew T. and Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania and Ojerholm, Eric and Roses, Robert E., E-mail: Robert.Roses@uphs.upenn.edu and Plastaras, John P. and Metz, James M. and Mamtani, Ronac and Karakousis, Giorgos C. and Fraker, Douglas L. and Drebin, Jeffrey A. and Stripp, Diana and Ben-Josef, Edgar and Datta, Jashodeep},
abstractNote = {Purpose: Prolonged radiation therapy treatment time (RTT) is associated with worse survival in several tumor types. This study investigated whether delays during adjuvant radiation therapy impact overall survival (OS) in gastric cancer. Methods and Materials: The National Cancer Data Base was queried for patients with resected gastric cancer who received adjuvant radiation therapy with National Comprehensive Cancer Network–recommended doses (45 or 50.4 Gy) between 1998 and 2006. RTT was classified as standard (45 Gy: 33-36 days, 50.4 Gy: 38-41 days) or prolonged (45 Gy: >36 days, 50.4 Gy: >41 days). Cox proportional hazards models evaluated the association between the following factors and OS: RTT, interval from surgery to radiation therapy initiation, interval from surgery to radiation therapy completion, radiation therapy dose, demographic/pathologic and operative factors, and other elements of adjuvant multimodality therapy. Results: Of 1591 patients, RTT was delayed in 732 (46%). Factors associated with prolonged RTT were non-private health insurance (OR 1.3, P=.005) and treatment at non-academic facilities (OR 1.2, P=.045). Median OS and 5-year actuarial survival were significantly worse in patients with prolonged RTT compared with standard RTT (36 vs 51 months, P=.001; 39 vs 47%, P=.005); OS worsened with each cumulative week of delay (P<.0004). On multivariable analysis, prolonged RTT was associated with inferior OS (hazard ratio 1.2, P=.002); the intervals from surgery to radiation therapy initiation or completion were not. Prolonged RTT was particularly detrimental in patients with node positivity, inadequate nodal staging (<15 nodes examined), and those undergoing a cycle of chemotherapy before chemoradiation therapy. Conclusions: Delays during adjuvant radiation therapy appear to negatively impact survival in gastric cancer. Efforts to minimize cumulative interruptions to <7 days should be considered.},
doi = {10.1016/J.IJROBP.2015.05.025},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 93,
place = {United States},
year = {2015},
month = {10}
}