Definitive pelvic radiotherapy and survival of patients with newly diagnosed metastatic anal cancer

Yuefeng Wang, Xinhua Yu, Nan Zhao, Jiajing Wang, Chi Lin, Enrique Izaguirre, Michael Farmer, Gary Tian, Bradley Somer, Nilesh Dubal, David Schwartz, Matthew Ballo, Noam Vanderwalde

Research output: Contribution to journalArticle

Abstract

Background: Chemotherapy with or without pelvic radiotherapy (RT) is included in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for metastatic anal cancer (MAC), despite limited clinical evidence for RT in this setting. In addition, increasing evidence shows that local therapies, including RT, may increase patient survival for some types of metastatic cancers. The purpose of this study was to evaluate the patterns of care and association between definitive pelvic RT and overall survival (OS) for patients with MAC. Methods: The National Cancer Database was analyzed to evaluate OS of patients with newly diagnosed MAC treated with chemotherapy with or without pelvic RT. Those who did not undergo treatment, treated with surgery, or without baseline variables were excluded. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score–matched analyses. Results: From 2004 through 2015, 437 patients received chemotherapy alone and 1,020 received pelvic chemoradiotherapy (CRT). At a median follow-up of 17.3 months, CRT was associated with improved OS on univariate (P<.001) and multivariate analysis (hazard ratio [HR], 0.70; 95% CI, 0.61–0.81; P<.001). Propensity score–matched analysis demonstrated superior median survival (21.3 vs 15.9 months) and 2-year OS rates (46% vs 34%) with CRT compared with chemotherapy alone (P<.001). Landmark analyses limited to long-term survivors of ≥1, ≥2, and ≥4 years showed improved OS with CRT in all subsets (all P<.05). CRT with therapeutic doses (≥45 Gy) was associated with longer median survival than palliative doses (<45 Gy) and chemotherapy alone (24.9 vs 10.9 vs 15.6 months, respectively; P<.001). The benefit of CRT was present among not only those with distant lymph node metastasis (HR, 0.63; P=.04) but also those with distant organ disease (HR, 0.74; P<.001). Conclusions: In this large hypothesis-generating analysis, patients with newly diagnosed MAC who received definitive pelvic RT with chemotherapy lived significantly longer than those who received chemotherapy alone. Prospective trials evaluating definitive local RT for MAC are warranted.

Original languageEnglish (US)
Pages (from-to)9-37
Number of pages29
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Anus Neoplasms
Chemoradiotherapy
Radiotherapy
Survival
Drug Therapy
Practice Guidelines
Proportional Hazards Models
Survivors
Neoplasms
Therapeutics
Multivariate Analysis
Survival Rate
Lymph Nodes
Databases
Guidelines
Neoplasm Metastasis

All Science Journal Classification (ASJC) codes

  • Oncology

Cite this

Definitive pelvic radiotherapy and survival of patients with newly diagnosed metastatic anal cancer. / Wang, Yuefeng; Yu, Xinhua; Zhao, Nan; Wang, Jiajing; Lin, Chi; Izaguirre, Enrique; Farmer, Michael; Tian, Gary; Somer, Bradley; Dubal, Nilesh; Schwartz, David; Ballo, Matthew; Vanderwalde, Noam.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 17, No. 1, 01.01.2019, p. 9-37.

Research output: Contribution to journalArticle

Wang, Yuefeng ; Yu, Xinhua ; Zhao, Nan ; Wang, Jiajing ; Lin, Chi ; Izaguirre, Enrique ; Farmer, Michael ; Tian, Gary ; Somer, Bradley ; Dubal, Nilesh ; Schwartz, David ; Ballo, Matthew ; Vanderwalde, Noam. / Definitive pelvic radiotherapy and survival of patients with newly diagnosed metastatic anal cancer. In: JNCCN Journal of the National Comprehensive Cancer Network. 2019 ; Vol. 17, No. 1. pp. 9-37.
@article{18cba64e837a4f628b81fbd8a509880e,
title = "Definitive pelvic radiotherapy and survival of patients with newly diagnosed metastatic anal cancer",
abstract = "Background: Chemotherapy with or without pelvic radiotherapy (RT) is included in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for metastatic anal cancer (MAC), despite limited clinical evidence for RT in this setting. In addition, increasing evidence shows that local therapies, including RT, may increase patient survival for some types of metastatic cancers. The purpose of this study was to evaluate the patterns of care and association between definitive pelvic RT and overall survival (OS) for patients with MAC. Methods: The National Cancer Database was analyzed to evaluate OS of patients with newly diagnosed MAC treated with chemotherapy with or without pelvic RT. Those who did not undergo treatment, treated with surgery, or without baseline variables were excluded. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score–matched analyses. Results: From 2004 through 2015, 437 patients received chemotherapy alone and 1,020 received pelvic chemoradiotherapy (CRT). At a median follow-up of 17.3 months, CRT was associated with improved OS on univariate (P<.001) and multivariate analysis (hazard ratio [HR], 0.70; 95{\%} CI, 0.61–0.81; P<.001). Propensity score–matched analysis demonstrated superior median survival (21.3 vs 15.9 months) and 2-year OS rates (46{\%} vs 34{\%}) with CRT compared with chemotherapy alone (P<.001). Landmark analyses limited to long-term survivors of ≥1, ≥2, and ≥4 years showed improved OS with CRT in all subsets (all P<.05). CRT with therapeutic doses (≥45 Gy) was associated with longer median survival than palliative doses (<45 Gy) and chemotherapy alone (24.9 vs 10.9 vs 15.6 months, respectively; P<.001). The benefit of CRT was present among not only those with distant lymph node metastasis (HR, 0.63; P=.04) but also those with distant organ disease (HR, 0.74; P<.001). Conclusions: In this large hypothesis-generating analysis, patients with newly diagnosed MAC who received definitive pelvic RT with chemotherapy lived significantly longer than those who received chemotherapy alone. Prospective trials evaluating definitive local RT for MAC are warranted.",
author = "Yuefeng Wang and Xinhua Yu and Nan Zhao and Jiajing Wang and Chi Lin and Enrique Izaguirre and Michael Farmer and Gary Tian and Bradley Somer and Nilesh Dubal and David Schwartz and Matthew Ballo and Noam Vanderwalde",
year = "2019",
month = "1",
day = "1",
doi = "10.6004/jnccn.2018.7085",
language = "English (US)",
volume = "17",
pages = "9--37",
journal = "Journal of the National Comprehensive Cancer Network : JNCCN",
issn = "1540-1405",
publisher = "Cold Spring Publishing LLC",
number = "1",

}

TY - JOUR

T1 - Definitive pelvic radiotherapy and survival of patients with newly diagnosed metastatic anal cancer

AU - Wang, Yuefeng

AU - Yu, Xinhua

AU - Zhao, Nan

AU - Wang, Jiajing

AU - Lin, Chi

AU - Izaguirre, Enrique

AU - Farmer, Michael

AU - Tian, Gary

AU - Somer, Bradley

AU - Dubal, Nilesh

AU - Schwartz, David

AU - Ballo, Matthew

AU - Vanderwalde, Noam

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Chemotherapy with or without pelvic radiotherapy (RT) is included in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for metastatic anal cancer (MAC), despite limited clinical evidence for RT in this setting. In addition, increasing evidence shows that local therapies, including RT, may increase patient survival for some types of metastatic cancers. The purpose of this study was to evaluate the patterns of care and association between definitive pelvic RT and overall survival (OS) for patients with MAC. Methods: The National Cancer Database was analyzed to evaluate OS of patients with newly diagnosed MAC treated with chemotherapy with or without pelvic RT. Those who did not undergo treatment, treated with surgery, or without baseline variables were excluded. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score–matched analyses. Results: From 2004 through 2015, 437 patients received chemotherapy alone and 1,020 received pelvic chemoradiotherapy (CRT). At a median follow-up of 17.3 months, CRT was associated with improved OS on univariate (P<.001) and multivariate analysis (hazard ratio [HR], 0.70; 95% CI, 0.61–0.81; P<.001). Propensity score–matched analysis demonstrated superior median survival (21.3 vs 15.9 months) and 2-year OS rates (46% vs 34%) with CRT compared with chemotherapy alone (P<.001). Landmark analyses limited to long-term survivors of ≥1, ≥2, and ≥4 years showed improved OS with CRT in all subsets (all P<.05). CRT with therapeutic doses (≥45 Gy) was associated with longer median survival than palliative doses (<45 Gy) and chemotherapy alone (24.9 vs 10.9 vs 15.6 months, respectively; P<.001). The benefit of CRT was present among not only those with distant lymph node metastasis (HR, 0.63; P=.04) but also those with distant organ disease (HR, 0.74; P<.001). Conclusions: In this large hypothesis-generating analysis, patients with newly diagnosed MAC who received definitive pelvic RT with chemotherapy lived significantly longer than those who received chemotherapy alone. Prospective trials evaluating definitive local RT for MAC are warranted.

AB - Background: Chemotherapy with or without pelvic radiotherapy (RT) is included in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for metastatic anal cancer (MAC), despite limited clinical evidence for RT in this setting. In addition, increasing evidence shows that local therapies, including RT, may increase patient survival for some types of metastatic cancers. The purpose of this study was to evaluate the patterns of care and association between definitive pelvic RT and overall survival (OS) for patients with MAC. Methods: The National Cancer Database was analyzed to evaluate OS of patients with newly diagnosed MAC treated with chemotherapy with or without pelvic RT. Those who did not undergo treatment, treated with surgery, or without baseline variables were excluded. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score–matched analyses. Results: From 2004 through 2015, 437 patients received chemotherapy alone and 1,020 received pelvic chemoradiotherapy (CRT). At a median follow-up of 17.3 months, CRT was associated with improved OS on univariate (P<.001) and multivariate analysis (hazard ratio [HR], 0.70; 95% CI, 0.61–0.81; P<.001). Propensity score–matched analysis demonstrated superior median survival (21.3 vs 15.9 months) and 2-year OS rates (46% vs 34%) with CRT compared with chemotherapy alone (P<.001). Landmark analyses limited to long-term survivors of ≥1, ≥2, and ≥4 years showed improved OS with CRT in all subsets (all P<.05). CRT with therapeutic doses (≥45 Gy) was associated with longer median survival than palliative doses (<45 Gy) and chemotherapy alone (24.9 vs 10.9 vs 15.6 months, respectively; P<.001). The benefit of CRT was present among not only those with distant lymph node metastasis (HR, 0.63; P=.04) but also those with distant organ disease (HR, 0.74; P<.001). Conclusions: In this large hypothesis-generating analysis, patients with newly diagnosed MAC who received definitive pelvic RT with chemotherapy lived significantly longer than those who received chemotherapy alone. Prospective trials evaluating definitive local RT for MAC are warranted.

UR - http://www.scopus.com/inward/record.url?scp=85060165107&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060165107&partnerID=8YFLogxK

U2 - 10.6004/jnccn.2018.7085

DO - 10.6004/jnccn.2018.7085

M3 - Article

VL - 17

SP - 9

EP - 37

JO - Journal of the National Comprehensive Cancer Network : JNCCN

JF - Journal of the National Comprehensive Cancer Network : JNCCN

SN - 1540-1405

IS - 1

ER -