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Gastroesophageal Junction Carcinoma
E150
International Journal of Radiation Oncology Biology Physics
2365
Yonsei University College of Medicine, Seoul, South Korea, 2Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea, The Republic of Korea, 3Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, The Republic of Korea, 4Department of Radiation Oncology, Severance Hospital of the Yonsei University Health System, Seoul, Korea, The Republic of Korea
Predictors of Esophageal Stricture After Definitive Chemoradiation Therapy for Esophageal/Gastroesophageal Junction Carcinoma L. Zamdborg,1 K.C. Lee,1 A. Harris,2 F. Doo,2 T. Bazil,3 Y. Xu,4 D.B. Gersten,5 I.S. Grills,5 J. Robertson,1 and J.S. Stromberg6; 1Beaumont Health, Royal Oak, MI, 2Oakland University William Beaumont School of Medicine, Rochester, MI, 3Kentucky College of Osteopathic Medicine, Pikeville, KY, 4Wayne State University, Detroit, MI, 5Beaumont Health System, Royal Oak, MI, 6Beaumont Health System, Troy, MI Purpose/Objective(s): To identify patient, tumor, and treatment factors that have a significant impact on the likelihood of developing esophageal stricture following definitive chemoradiation therapy (CRT) for esophageal/gastroesophageal junction (GEJ) carcinoma. Materials/Methods: From 1999 to 2015, 100 patients underwent definitive concurrent chemoradiation therapy for carcinoma of the non-cervical esophagus at a single institution. The median age was 74 years (range, 4292), and 65% were female. Disease grade (1, 2, and 3) was 4%, 24%, 49%, and not reported for 23%. Twenty-seven percent had squamous histology. Four percent of tumors were found in the proximal third of the esophagus, 15% in the middle third, 69% in the distal third, and 12% in the GEJ only. AJCC 6 clinical stage (I/IIA/IIB/III/IVA/TxN0M0) was 7%/18%/9%/35%/ 21%/10%. The majority (83%) had smoked, and 17% were current smokers. Median RT dose was 50.4 Gy (14-64.8). Thirteen percent of the cohort received more than 54 Gy. Seven percent received BID fractionation, typically to 45 Gy. Thirty-seven percent were treated with IMRT, 63% with 3DCRT. Seventy-three percent received multiagent chemotherapy. Seventy-two percent of all patients received a platinum, 24% a taxane, and 57% a fluoropyrimidine. Patients were followed by surgery, medical oncology, and radiation oncology on an alternating basis. Time to stricture was defined as elapsed time from completion of RT to first dilatation. Prophylactic dilatations were not performed. Multiple patient, treatment, and tumor characteristics had descriptive statistics calculated. Crude survival and recurrence rates were calculated by the Kaplan-Meier method. Cumulative incidence of post-treatment stricture relative to death was estimated by the Aalen-Johansen method. Effects of various predictors on the risk of stricture, with death as a competing risk, were estimated with univariate and multivariate Fine-Gray models. Results: Median follow-up was 1.35 y (0.07-10.08). Median OS was 1.63 y, and 1 yr OS was 64.3%. The 1 yr cumulative incidence of stricture was 20.7%. Tumor location was significantly (P Z 0.009) associated with stricture risk, with more superior tumors having higher rates of stricture (1 yr stricture incidence 75%, 13.9%, 21.0%, and 8.3% respectively for proximal/middle/distal/GEJ tumors). Platinum-containing chemotherapy regimens were also significantly (P Z 0.005) associated with decreased stricture risk (1 yr stricture incidence 13.0% vs 39.2%). Patient age, sex, current or previous smoking history, alcohol use, stage group, RT technique, and the use of a dose above 54 Gy were not associated with stricture risk. Conclusion: In this series, patients with more inferior esophageal tumors and treated with concurrent chemotherapy incorporating platinum agents had a decreased risk of stricture relative to those who did not, and EBRT dose did not appear to affect the estimated incidence of stricture. Doseescalation may be feasible in the inferior esophagus without affecting the rate of stricture, while more superior tumors may benefit from prophylactic dilatation. Author Disclosure: L. Zamdborg: None. K.C. Lee: None. A. Harris: None. F. Doo: None. T. Bazil: None. Y. Xu: None. D.B. Gersten: None. I.S. Grills: None. J. Robertson: None. J.S. Stromberg: None.
2366 Risk Factors Associated With Locoregional Failure After Surgical Resection in Patients With Resectable Pancreatic Cancer H.J. Kim,1 W.J. Lee,2 C.M. Kang,2 H.K. Hwang,2 S.M. Bang,3 S.Y. Song,3 and J. Seong4; 1Department of Radiation Oncology, Yonsei Cancer Center,
Purpose/Objective(s): To evaluate the risk factors associated with locoregional failure after surgical resection and to identify the subgroup that can obtain benefits from adjuvant radiation therapy. Materials/Methods: We identified patients treated with surgical resection for resectable pancreatic cancer at Severance hospital between January 1993 and December 2014. Patients who received any neoadjuvant or adjuvant RT were excluded. A total of 175 patients were included. The primary sites of involvement were the head in 122 patients (69.7%), body in 36 (20.6%), and tail in 17 (9.7%). Most of the patients (82.3% of all patients) were diagnosed with ductal adenocarcinoma, while mucinous carcinoma in 6 patients, acinar cell carcinoma in 4 patients and IPMN with invasiveness in 21 patients. Resection margin status was R0 in 159 patients (91%) and R1 in 15 patients (9%). The median initial CA 19-9 level was 90.3 U/mL (range, 0.1 e 20,000 U/mL). Adjuvant chemotherapy was performed in 107 patients (61.1%) with either a gemcitabine-based regimen (65.4%) or 5-FU based one (34.9%). Study endpoints were loco-regional failure-free survival (LRFFS) and overall survival (OS). Results: The median loco-regional failure-free survival (LRFFS) and overall survival (OS) were 23.9 and 33.6 months, respectively with a median follow-up period of 21 months (4.0 - 109.2 months). One hundred eight of 175 patients (61.7%) developed a recurrence during followup period. The predominant pattern of the first failure was distant metastasis (42.4%): mainly in the liver (n Z 50), peritoneum (n Z 14), lung (n Z 10), para-aortic lymph node (n Z 3), and bone (n Z 2). 47 patients (26.9%) developed local failure as the first site of recurrence. Multivariate analysis identified initial CA 19-9 ( 250 U/mL), N stage (N1), perineural invasion (PNI), and positive resection margin as significant independent risk factors associated with LRFFS. All patients were divided into four groups according to the number of risk factors, including initial CA 19-9 ( 250 U/mL), N stage, and PNI. Positive resection margin is already known prognostic factor that needs adjuvant RT, resection margin was not counted for the risk factor in the following analysis. Patients exhibiting two risk factors had 3.7-fold higher locoregional failure (P < 0.001, 95% CI 1.93-7.11) and patients with all risk factors showed a 7-fold increase (P < 0.001, 95% CI 3.26-14.68) compared with those with no risk factors. In the analysis for OS, patients with more than two risk factors also had 4- to 6-fold higher risk of death with statistical significance. Conclusion: The results suggest the necessity of radiation therapy as an effective local adjuvant treatment to improve survival outcome, especially in patients exhibiting more than two risk factors. To clarify the role of adjuvant RT, future well designed randomized controlled studies are warranted. Author Disclosure: H. Kim: None. W. Lee: None. C. Kang: None. H. Hwang: None. S. Bang: None. S. Song: None. J. Seong: None.
2367 Integration of Radiation Therapy to Chemotherapy for Abdominal Lymph Node Recurrence in Gastric Cancer J. Lee,1 J.S. Lim,2 H.S. Kim,3 and W.S. Koom4; 1Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, The Republic of Korea, 2Department of Radiology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, The Republic of Korea, 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, The Republic of Korea, 4Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea, The Republic of Korea
International Journal of Radiation Oncology Biology Physics
2365
Yonsei University College of Medicine, Seoul, South Korea, 2Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea, The Republic of Korea, 3Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, The Republic of Korea, 4Department of Radiation Oncology, Severance Hospital of the Yonsei University Health System, Seoul, Korea, The Republic of Korea
Predictors of Esophageal Stricture After Definitive Chemoradiation Therapy for Esophageal/Gastroesophageal Junction Carcinoma L. Zamdborg,1 K.C. Lee,1 A. Harris,2 F. Doo,2 T. Bazil,3 Y. Xu,4 D.B. Gersten,5 I.S. Grills,5 J. Robertson,1 and J.S. Stromberg6; 1Beaumont Health, Royal Oak, MI, 2Oakland University William Beaumont School of Medicine, Rochester, MI, 3Kentucky College of Osteopathic Medicine, Pikeville, KY, 4Wayne State University, Detroit, MI, 5Beaumont Health System, Royal Oak, MI, 6Beaumont Health System, Troy, MI Purpose/Objective(s): To identify patient, tumor, and treatment factors that have a significant impact on the likelihood of developing esophageal stricture following definitive chemoradiation therapy (CRT) for esophageal/gastroesophageal junction (GEJ) carcinoma. Materials/Methods: From 1999 to 2015, 100 patients underwent definitive concurrent chemoradiation therapy for carcinoma of the non-cervical esophagus at a single institution. The median age was 74 years (range, 4292), and 65% were female. Disease grade (1, 2, and 3) was 4%, 24%, 49%, and not reported for 23%. Twenty-seven percent had squamous histology. Four percent of tumors were found in the proximal third of the esophagus, 15% in the middle third, 69% in the distal third, and 12% in the GEJ only. AJCC 6 clinical stage (I/IIA/IIB/III/IVA/TxN0M0) was 7%/18%/9%/35%/ 21%/10%. The majority (83%) had smoked, and 17% were current smokers. Median RT dose was 50.4 Gy (14-64.8). Thirteen percent of the cohort received more than 54 Gy. Seven percent received BID fractionation, typically to 45 Gy. Thirty-seven percent were treated with IMRT, 63% with 3DCRT. Seventy-three percent received multiagent chemotherapy. Seventy-two percent of all patients received a platinum, 24% a taxane, and 57% a fluoropyrimidine. Patients were followed by surgery, medical oncology, and radiation oncology on an alternating basis. Time to stricture was defined as elapsed time from completion of RT to first dilatation. Prophylactic dilatations were not performed. Multiple patient, treatment, and tumor characteristics had descriptive statistics calculated. Crude survival and recurrence rates were calculated by the Kaplan-Meier method. Cumulative incidence of post-treatment stricture relative to death was estimated by the Aalen-Johansen method. Effects of various predictors on the risk of stricture, with death as a competing risk, were estimated with univariate and multivariate Fine-Gray models. Results: Median follow-up was 1.35 y (0.07-10.08). Median OS was 1.63 y, and 1 yr OS was 64.3%. The 1 yr cumulative incidence of stricture was 20.7%. Tumor location was significantly (P Z 0.009) associated with stricture risk, with more superior tumors having higher rates of stricture (1 yr stricture incidence 75%, 13.9%, 21.0%, and 8.3% respectively for proximal/middle/distal/GEJ tumors). Platinum-containing chemotherapy regimens were also significantly (P Z 0.005) associated with decreased stricture risk (1 yr stricture incidence 13.0% vs 39.2%). Patient age, sex, current or previous smoking history, alcohol use, stage group, RT technique, and the use of a dose above 54 Gy were not associated with stricture risk. Conclusion: In this series, patients with more inferior esophageal tumors and treated with concurrent chemotherapy incorporating platinum agents had a decreased risk of stricture relative to those who did not, and EBRT dose did not appear to affect the estimated incidence of stricture. Doseescalation may be feasible in the inferior esophagus without affecting the rate of stricture, while more superior tumors may benefit from prophylactic dilatation. Author Disclosure: L. Zamdborg: None. K.C. Lee: None. A. Harris: None. F. Doo: None. T. Bazil: None. Y. Xu: None. D.B. Gersten: None. I.S. Grills: None. J. Robertson: None. J.S. Stromberg: None.
2366 Risk Factors Associated With Locoregional Failure After Surgical Resection in Patients With Resectable Pancreatic Cancer H.J. Kim,1 W.J. Lee,2 C.M. Kang,2 H.K. Hwang,2 S.M. Bang,3 S.Y. Song,3 and J. Seong4; 1Department of Radiation Oncology, Yonsei Cancer Center,
Purpose/Objective(s): To evaluate the risk factors associated with locoregional failure after surgical resection and to identify the subgroup that can obtain benefits from adjuvant radiation therapy. Materials/Methods: We identified patients treated with surgical resection for resectable pancreatic cancer at Severance hospital between January 1993 and December 2014. Patients who received any neoadjuvant or adjuvant RT were excluded. A total of 175 patients were included. The primary sites of involvement were the head in 122 patients (69.7%), body in 36 (20.6%), and tail in 17 (9.7%). Most of the patients (82.3% of all patients) were diagnosed with ductal adenocarcinoma, while mucinous carcinoma in 6 patients, acinar cell carcinoma in 4 patients and IPMN with invasiveness in 21 patients. Resection margin status was R0 in 159 patients (91%) and R1 in 15 patients (9%). The median initial CA 19-9 level was 90.3 U/mL (range, 0.1 e 20,000 U/mL). Adjuvant chemotherapy was performed in 107 patients (61.1%) with either a gemcitabine-based regimen (65.4%) or 5-FU based one (34.9%). Study endpoints were loco-regional failure-free survival (LRFFS) and overall survival (OS). Results: The median loco-regional failure-free survival (LRFFS) and overall survival (OS) were 23.9 and 33.6 months, respectively with a median follow-up period of 21 months (4.0 - 109.2 months). One hundred eight of 175 patients (61.7%) developed a recurrence during followup period. The predominant pattern of the first failure was distant metastasis (42.4%): mainly in the liver (n Z 50), peritoneum (n Z 14), lung (n Z 10), para-aortic lymph node (n Z 3), and bone (n Z 2). 47 patients (26.9%) developed local failure as the first site of recurrence. Multivariate analysis identified initial CA 19-9 ( 250 U/mL), N stage (N1), perineural invasion (PNI), and positive resection margin as significant independent risk factors associated with LRFFS. All patients were divided into four groups according to the number of risk factors, including initial CA 19-9 ( 250 U/mL), N stage, and PNI. Positive resection margin is already known prognostic factor that needs adjuvant RT, resection margin was not counted for the risk factor in the following analysis. Patients exhibiting two risk factors had 3.7-fold higher locoregional failure (P < 0.001, 95% CI 1.93-7.11) and patients with all risk factors showed a 7-fold increase (P < 0.001, 95% CI 3.26-14.68) compared with those with no risk factors. In the analysis for OS, patients with more than two risk factors also had 4- to 6-fold higher risk of death with statistical significance. Conclusion: The results suggest the necessity of radiation therapy as an effective local adjuvant treatment to improve survival outcome, especially in patients exhibiting more than two risk factors. To clarify the role of adjuvant RT, future well designed randomized controlled studies are warranted. Author Disclosure: H. Kim: None. W. Lee: None. C. Kang: None. H. Hwang: None. S. Bang: None. S. Song: None. J. Seong: None.
2367 Integration of Radiation Therapy to Chemotherapy for Abdominal Lymph Node Recurrence in Gastric Cancer J. Lee,1 J.S. Lim,2 H.S. Kim,3 and W.S. Koom4; 1Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, The Republic of Korea, 2Department of Radiology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, The Republic of Korea, 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, The Republic of Korea, 4Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea, The Republic of Korea