Stage-specific Survival Differences Associated with Postoperative Radiotherapy for Gastrointestinal Cancers

Overview

Journal J Gastrointest Cancer

Publisher Springer

Specialties Gastroenterology
Oncology

Date 2009 Mar 19

PMID 19294536

Citations 2

Authors

John S Moody

Stephen M Sawrie

Kevin R Kozak

John P Plastaras

George Howard

James A Bonner

Affiliations

Soon will be listed here.

Abstract

Objective: To study the frequency and effect associated with postoperative radiotherapy (RT) for patients with resected gastrointestinal (GI) cancers.

Materials And Methods: In observational cohort from the Surveillance, Epidemiology, and End Results (SEER) program, a total of 23,049 patients were identified with resected pancreatic, gastric, esophageal, or rectal carcinomas diagnosed from 1988 to 2003. Using a propensity score analysis, survival differences associated with postoperative RT were analyzed.

Results: Adjuvant RT was given to 51.2%, 26.3%, 33.0%, and 58.0% of pancreatic, gastric, esophageal, and rectal cancer patients, respectively. Age and stage of disease were associated with RT use for each site (P < 0.001), with younger patients and those with advanced disease receiving RT more frequently. Postoperative RT was associated with a survival benefit for patients with pancreatic cancer (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.79-0.96), gastric cancer (HR, 0.93; 95% CI, 0.87-0.99), and rectal cancer (HR, 0.84; 95% CI, 0.79-0.90). Subgroups of patients were also identified who experienced the greatest improvement in survival with RT (stage IIB pancreatic cancer, HR = 0.71 [95% CI 0.62-0.80]; stage IIIA and IV gastric cancer, HR = 0.86 [95% CI 0.77-0.97] and HR = 0.77 [95% CI 0.67-0.89], respectively; stages IIA, IIIB, and IIIC rectal cancer, HR = 0.87 [95% CI 0.78-0.97], HR = 0.71 [95% CI 0.63-0.80], and HR = 0.79 [95% CI 0.70-0.90], respectively).

Conclusion: Postoperative RT is associated with improved survival for patients who undergo curative resection of pancreatic, gastric, and rectal malignancies. Significant differences are observed for this effect according to stage of disease, with more advanced cases in general experiencing a greater benefit with RT.

Citing Articles

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Interval between Surgery and Radiation Therapy Is an Important Prognostic Factor in Treatment of Rectal Cancer.

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References

Crane C, Ben-Josef E, Small Jr W . Chemotherapy for pancreatic cancer. N Engl J Med. 2004; 350(26):2713-5. View

Moody J, Sawrie S, Kozak K, Plastaras J, Howard G, Bonner J . Adjuvant radiotherapy for pancreatic cancer is associated with a survival benefit primarily in stage IIB patients. J Gastroenterol. 2009; 44(1):84-91. DOI: 10.1007/s00535-008-2280-8. View

Burmeister B, Smithers B, Gebski V, Fitzgerald L, Simes R, Devitt P . Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol. 2005; 6(9):659-68. DOI: 10.1016/S1470-2045(05)70288-6. View

Neoptolemos J, Stocken D, Friess H, Bassi C, Dunn J, Hickey H . A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004; 350(12):1200-10. DOI: 10.1056/NEJMoa032295. View

Dumont P, Wihlm J, Roeslin N, Massard G, Lion R, Morand G . [Result of surgery of esophageal cancer. Analysis of a series of 349 cases based on resection methods]. Ann Chir. 1993; 47(8):773-83. View

Walsh T, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy T . A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996; 335(7):462-7. DOI: 10.1056/NEJM199608153350702. View

Neoptolemos J, Dunn J, Stocken D, Almond J, Link K, Beger H . Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet. 2001; 358(9293):1576-85. DOI: 10.1016/s0140-6736(01)06651-x. View

Macdonald J, Smalley S, Benedetti J, Hundahl S, Estes N, STEMMERMANN G . Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001; 345(10):725-30. DOI: 10.1056/NEJMoa010187. View

Coburn N, Govindarajan A, Law C, Guller U, Kiss A, Ringash J . Stage-specific effect of adjuvant therapy following gastric cancer resection: a population-based analysis of 4,041 patients. Ann Surg Oncol. 2007; 15(2):500-7. DOI: 10.1245/s10434-007-9640-0. View

10.

LAWRENCE Jr W, Menck H, Steele Jr G, WINCHESTER D . The National Cancer Data Base report on gastric cancer. Cancer. 1995; 75(7):1734-44. DOI: 10.1002/1097-0142(19950401)75:7<1734::aid-cncr2820750729>3.0.co;2-e. View

11.

Tveit K, Guldvog I, Hagen S, Trondsen E, Harbitz T, Nygaard K . Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. Norwegian Adjuvant Rectal Cancer Project Group. Br J Surg. 1997; 84(8):1130-5. View

12.

Urba S, Orringer M, Turrisi A, Iannettoni M, Forastiere A, Strawderman M . Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol. 2001; 19(2):305-13. DOI: 10.1200/JCO.2001.19.2.305. View

13.

Wolmark N, Wieand H, Hyams D, Colangelo L, Dimitrov N, Romond E . Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst. 2000; 92(5):388-96. DOI: 10.1093/jnci/92.5.388. View

14.

Rubin D . Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1998; 127(8 Pt 2):757-63. DOI: 10.7326/0003-4819-127-8_part_2-199710151-00064. View

15.

Wilson G, Bentzen S, Harari P . Biologic basis for combining drugs with radiation. Semin Radiat Oncol. 2005; 16(1):2-9. DOI: 10.1016/j.semradonc.2005.08.001. View

16.

Artinyan A, Hellan M, Mojica-Manosa P, Chen Y, Pezner R, Ellenhorn J . Improved survival with adjuvant external-beam radiation therapy in lymph node-negative pancreatic cancer: a United States population-based assessment. Cancer. 2007; 112(1):34-42. DOI: 10.1002/cncr.23134. View

17.

Jessup J, Stewart A, Menck H . The National Cancer Data Base report on patterns of care for adenocarcinoma of the rectum, 1985-95. Cancer. 1998; 83(11):2408-18. DOI: 10.1002/(sici)1097-0142(19981201)83:11<2408::aid-cncr22>3.0.co;2-g. View

18.

Dobie S, Warren J, Matthews B, Schwartz D, Baldwin L, Billingsley K . Survival benefits and trends in use of adjuvant therapy among elderly stage II and III rectal cancer patients in the general population. Cancer. 2008; 112(4):789-99. PMC: 3103394. DOI: 10.1002/cncr.23244. View

19.

Suntharalingam M, Moughan J, Coia L, Krasna M, Kachnic L, Haller D . Outcome results of the 1996-1999 patterns of care survey of the national practice for patients receiving radiation therapy for carcinoma of the esophagus. J Clin Oncol. 2005; 23(10):2325-31. DOI: 10.1200/JCO.2005.00.448. View

20.

Douglass Jr H, MOERTEL C, Mayer R, Thomas P, Lindblad A, Mittleman A . Survival after postoperative combination treatment of rectal cancer. N Engl J Med. 1986; 315(20):1294-5. DOI: 10.1056/NEJM198611133152014. View