(S018) Intensity-Modulated Radiation Therapy or Conformal Radiation Therapy and Cardiopulmonary Mortality Risk in the Elderly With Esophageal Cancer

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

In this population-based analysis, IMRT use was significantly associated with improved overall survival and reduced cardiac mortality in patients with esophageal cancer.

Steven H. Lin, MD, PhD, Ning Zhang, PhD, Joy Godby, BS, Jingya Wang, MD, Gary D. Marsh, BS, Zhongxing Liao, MD, Ritsuko Komaki, MD, Linus Ho, MD, Wayne L. Hofstetter, MD, Stephen G. Swisher, MD, Thomas A. Buchholz, MD, Linda S. Elting, PhD, Sharon H. Giordano, MD; UT MD Anderson Cancer Center

PURPOSE: We performed a population-based assessment for the all-cause and cardiopulmonary mortality risk in esophageal cancer (EC) patients treated with chemotherapy and radiation, comparing conventional radiotherapy (CRT) or advanced radiation modality defined by the use of intensity-modulated radiation therapy (IMRT). 

PATIENTS AND METHODS: We identified 2,578 patients aged over 65 years from the Surveillance, Epidemiology, and End Results (SEER)/Texas Cancer Registry-Medicare databases who had nonmetastatic EC diagnosed between 2002 and 2009 (CRT = 2,265; IMRT = 313). We defined radiation modality by delivery claims, whether it was by conventional radiation therapy, which could either have been two-dimensional (2D) or three-dimensional (3D) (CRT: Healthcare Common Procedure Coding System [HCPCS]: 77401–77416) or by IMRT delivery (HCPCS: 77418, G0174) within 6 months of diagnosis. Patients in both cohorts were compared using propensity score–based adjustment. Cause-specific and overall mortality rates were evaluated using Kaplan-Meier LIFETEST and a multivariate (MVA) Cox proportional hazards model. 

RESULTS: Except for marital status and SEER region, both radiation cohorts were well balanced for various patient, tumor, and treatment characteristics, including the distribution of the use of IMRT vs CRT in urban/metropolitan or rural areas. CRT was done primarily by 3D delivery (98.9%). IMRT use increased from 2.6% in 2002 to 30% in 2009, while 3D use decreased from 97.4% in 2002 to 70% in 2009. In the unadjusted analysis, all-cause mortality, EC-specific mortality, and cardiac mortality were significantly reduced in the IMRT group (all: 52.4% vs 74.5%, P < .0001; EC: 40.3% vs 55.6%, P < .0001; and cardiac: 1.6% vs 5.3%, P = .0043). However, no difference was seen in deaths from pulmonary (0.96% vs 1.55%; P = .419) or other causes (9.6% vs 12.1%; P = .204). On propensity score–adjusted MVA, IMRT was not associated with EC-specific mortality (hazard ratio [HR] = 0.87; 95% confidence interval [CI], 0.69–1.06), pulmonary (HR = 1.04; 95% CI, 0.29–3.79), or other-cause mortality (HR = 0.81; 95% CI, 0.54–1.22) but was significantly associated with higher overall survival (HR = 0.83; 95% CI, 0.70–0.98) and lower cardiac mortality (HR = 0.35; 95% CI, 0.14–0.88). Similar associations were seen even after adjusting for physician experience, the type of chemotherapy used, and sensitivity analysis removing hybrid radiation claims. 

CONCLUSION: In this population-based analysis, IMRT use was significantly associated with improved overall survival and reduced cardiac mortality in patients with esophageal cancer.

Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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