Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer

Steven H. Lin, Kenneth W. Merrell, Jincheng Shen, Vivek Verma, Arlene M. Correa, Lu Wang, Peter F. Thall, Neha Bhooshan, Sarah E. James, Michael Haddock, Mohan Suntharalingam, Minesh P. Mehta, Zhongxing Liao, James D. Cox, Ritsuko Komaki, Reza J. Mehran, Michael D. Chuong, Christopher Hallemeier

Research output: Contribution to journalArticle

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Abstract

Purpose Relative radiation dose exposure to vital organs in the thorax could influence clinical outcomes in esophageal cancer (EC). We assessed whether the type of radiation therapy (RT) modality used was associated with postoperative outcomes after neoadjuvant chemoradiation (nCRT). Patients and methods Contemporary data from 580 EC patients treated with nCRT at 3 academic institutions from 2007 to 2013 were reviewed. 3D conformal RT (3D), intensity modulated RT (IMRT) and proton beam therapy (PBT) were used for 214 (37%), 255 (44%), and 111 (19%) patients, respectively. Postoperative outcomes included pulmonary, GI, cardiac, wound healing complications, length of in-hospital stay (LOS), and 90-day postoperative mortality. Cox model fits, and log-rank tests both with and without Inverse Probability of treatment Weighting (IPW) were used to correct for bias due to non-randomization. Results RT modality was significantly associated with the incidence of pulmonary, cardiac and wound complications, which also bore out on multivariate analysis. Mean LOS was also significantly associated with treatment modality (13.2 days for 3D (95%CI 11.7–14.7), 11.6 days for IMRT (95%CI 10.9–12.7), and 9.3 days for PBT (95%CI 8.2–10.3) (p < 0.0001)). The 90 day postoperative mortality rates were 4.2%, 4.3%, and 0.9%, respectively, for 3D, IMRT and PBT (p = 0.264). Conclusions Advanced RT technologies (IMRT and PBT) were associated with significantly reduced rate of postoperative complications and LOS compared to 3D, with PBT displaying the greatest benefit in a number of clinical endpoints. Ongoing prospective randomized trial will be needed to validate these results.

Original languageEnglish (US)
Pages (from-to)376-381
Number of pages6
JournalRadiotherapy and Oncology
Volume123
Issue number3
DOIs
StatePublished - Jun 1 2017

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Proton Therapy
Esophageal Neoplasms
Radiotherapy
Radiation
Lung
Mortality
Proportional Hazards Models
Wound Healing
Length of Stay
Thorax
Multivariate Analysis
Technology
Incidence
Wounds and Injuries
Therapeutics

Keywords

  • Esophageal carcinoma
  • Intensity modulated radiation therapy
  • Postoperative complications
  • Proton beam therapy
  • Radiation

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer. / Lin, Steven H.; Merrell, Kenneth W.; Shen, Jincheng; Verma, Vivek; Correa, Arlene M.; Wang, Lu; Thall, Peter F.; Bhooshan, Neha; James, Sarah E.; Haddock, Michael; Suntharalingam, Mohan; Mehta, Minesh P.; Liao, Zhongxing; Cox, James D.; Komaki, Ritsuko; Mehran, Reza J.; Chuong, Michael D.; Hallemeier, Christopher.

In: Radiotherapy and Oncology, Vol. 123, No. 3, 01.06.2017, p. 376-381.

Research output: Contribution to journalArticle

Lin, SH, Merrell, KW, Shen, J, Verma, V, Correa, AM, Wang, L, Thall, PF, Bhooshan, N, James, SE, Haddock, M, Suntharalingam, M, Mehta, MP, Liao, Z, Cox, JD, Komaki, R, Mehran, RJ, Chuong, MD & Hallemeier, C 2017, 'Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer', Radiotherapy and Oncology, vol. 123, no. 3, pp. 376-381. https://doi.org/10.1016/j.radonc.2017.04.013
Lin, Steven H. ; Merrell, Kenneth W. ; Shen, Jincheng ; Verma, Vivek ; Correa, Arlene M. ; Wang, Lu ; Thall, Peter F. ; Bhooshan, Neha ; James, Sarah E. ; Haddock, Michael ; Suntharalingam, Mohan ; Mehta, Minesh P. ; Liao, Zhongxing ; Cox, James D. ; Komaki, Ritsuko ; Mehran, Reza J. ; Chuong, Michael D. ; Hallemeier, Christopher. / Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer. In: Radiotherapy and Oncology. 2017 ; Vol. 123, No. 3. pp. 376-381.
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abstract = "Purpose Relative radiation dose exposure to vital organs in the thorax could influence clinical outcomes in esophageal cancer (EC). We assessed whether the type of radiation therapy (RT) modality used was associated with postoperative outcomes after neoadjuvant chemoradiation (nCRT). Patients and methods Contemporary data from 580 EC patients treated with nCRT at 3 academic institutions from 2007 to 2013 were reviewed. 3D conformal RT (3D), intensity modulated RT (IMRT) and proton beam therapy (PBT) were used for 214 (37{\%}), 255 (44{\%}), and 111 (19{\%}) patients, respectively. Postoperative outcomes included pulmonary, GI, cardiac, wound healing complications, length of in-hospital stay (LOS), and 90-day postoperative mortality. Cox model fits, and log-rank tests both with and without Inverse Probability of treatment Weighting (IPW) were used to correct for bias due to non-randomization. Results RT modality was significantly associated with the incidence of pulmonary, cardiac and wound complications, which also bore out on multivariate analysis. Mean LOS was also significantly associated with treatment modality (13.2 days for 3D (95{\%}CI 11.7–14.7), 11.6 days for IMRT (95{\%}CI 10.9–12.7), and 9.3 days for PBT (95{\%}CI 8.2–10.3) (p < 0.0001)). The 90 day postoperative mortality rates were 4.2{\%}, 4.3{\%}, and 0.9{\%}, respectively, for 3D, IMRT and PBT (p = 0.264). Conclusions Advanced RT technologies (IMRT and PBT) were associated with significantly reduced rate of postoperative complications and LOS compared to 3D, with PBT displaying the greatest benefit in a number of clinical endpoints. Ongoing prospective randomized trial will be needed to validate these results.",
keywords = "Esophageal carcinoma, Intensity modulated radiation therapy, Postoperative complications, Proton beam therapy, Radiation",
author = "Lin, {Steven H.} and Merrell, {Kenneth W.} and Jincheng Shen and Vivek Verma and Correa, {Arlene M.} and Lu Wang and Thall, {Peter F.} and Neha Bhooshan and James, {Sarah E.} and Michael Haddock and Mohan Suntharalingam and Mehta, {Minesh P.} and Zhongxing Liao and Cox, {James D.} and Ritsuko Komaki and Mehran, {Reza J.} and Chuong, {Michael D.} and Christopher Hallemeier",
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T1 - Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer

AU - Lin, Steven H.

AU - Merrell, Kenneth W.

AU - Shen, Jincheng

AU - Verma, Vivek

AU - Correa, Arlene M.

AU - Wang, Lu

AU - Thall, Peter F.

AU - Bhooshan, Neha

AU - James, Sarah E.

AU - Haddock, Michael

AU - Suntharalingam, Mohan

AU - Mehta, Minesh P.

AU - Liao, Zhongxing

AU - Cox, James D.

AU - Komaki, Ritsuko

AU - Mehran, Reza J.

AU - Chuong, Michael D.

AU - Hallemeier, Christopher

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Purpose Relative radiation dose exposure to vital organs in the thorax could influence clinical outcomes in esophageal cancer (EC). We assessed whether the type of radiation therapy (RT) modality used was associated with postoperative outcomes after neoadjuvant chemoradiation (nCRT). Patients and methods Contemporary data from 580 EC patients treated with nCRT at 3 academic institutions from 2007 to 2013 were reviewed. 3D conformal RT (3D), intensity modulated RT (IMRT) and proton beam therapy (PBT) were used for 214 (37%), 255 (44%), and 111 (19%) patients, respectively. Postoperative outcomes included pulmonary, GI, cardiac, wound healing complications, length of in-hospital stay (LOS), and 90-day postoperative mortality. Cox model fits, and log-rank tests both with and without Inverse Probability of treatment Weighting (IPW) were used to correct for bias due to non-randomization. Results RT modality was significantly associated with the incidence of pulmonary, cardiac and wound complications, which also bore out on multivariate analysis. Mean LOS was also significantly associated with treatment modality (13.2 days for 3D (95%CI 11.7–14.7), 11.6 days for IMRT (95%CI 10.9–12.7), and 9.3 days for PBT (95%CI 8.2–10.3) (p < 0.0001)). The 90 day postoperative mortality rates were 4.2%, 4.3%, and 0.9%, respectively, for 3D, IMRT and PBT (p = 0.264). Conclusions Advanced RT technologies (IMRT and PBT) were associated with significantly reduced rate of postoperative complications and LOS compared to 3D, with PBT displaying the greatest benefit in a number of clinical endpoints. Ongoing prospective randomized trial will be needed to validate these results.

AB - Purpose Relative radiation dose exposure to vital organs in the thorax could influence clinical outcomes in esophageal cancer (EC). We assessed whether the type of radiation therapy (RT) modality used was associated with postoperative outcomes after neoadjuvant chemoradiation (nCRT). Patients and methods Contemporary data from 580 EC patients treated with nCRT at 3 academic institutions from 2007 to 2013 were reviewed. 3D conformal RT (3D), intensity modulated RT (IMRT) and proton beam therapy (PBT) were used for 214 (37%), 255 (44%), and 111 (19%) patients, respectively. Postoperative outcomes included pulmonary, GI, cardiac, wound healing complications, length of in-hospital stay (LOS), and 90-day postoperative mortality. Cox model fits, and log-rank tests both with and without Inverse Probability of treatment Weighting (IPW) were used to correct for bias due to non-randomization. Results RT modality was significantly associated with the incidence of pulmonary, cardiac and wound complications, which also bore out on multivariate analysis. Mean LOS was also significantly associated with treatment modality (13.2 days for 3D (95%CI 11.7–14.7), 11.6 days for IMRT (95%CI 10.9–12.7), and 9.3 days for PBT (95%CI 8.2–10.3) (p < 0.0001)). The 90 day postoperative mortality rates were 4.2%, 4.3%, and 0.9%, respectively, for 3D, IMRT and PBT (p = 0.264). Conclusions Advanced RT technologies (IMRT and PBT) were associated with significantly reduced rate of postoperative complications and LOS compared to 3D, with PBT displaying the greatest benefit in a number of clinical endpoints. Ongoing prospective randomized trial will be needed to validate these results.

KW - Esophageal carcinoma

KW - Intensity modulated radiation therapy

KW - Postoperative complications

KW - Proton beam therapy

KW - Radiation

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