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Relationship Between Radiation Therapy Dose and Overall Survival in Anaplastic Thyroid Cancer: Analysis of the National Cancer Data Base
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Volume 96 Number 2S Supplement 2016 initial CT images. GTVSRs were calculated based on initial and re-planning CT images. Four patients (6%) received induction chemotherapy (IC). Fifty-seven patients (88%) received concurrent chemotherapy (CC) using following regimen: TPF [docetaxel (DTX), cisplatin (CDDP), and 5fluorouracil] (n Z 29, 44%); another CDDP-based menu (n Z 22, 34%); the other DTX-based menu (n Z 3, 5%); and cetuximab (n Z 3, 5%). Univariate analyses (UA) and multivariate analyses (MA) were performed to identify baseline factors related to the GTVSR. Potential variables include age, gender, T and N stage, use of IC, use of CC, CC menu, use of PEG, serum albumin (Alb), Alb globulin ratio (AGR), C-reactive protein (CRP), CBV, body weight (BW), and body mass index (BMI) before treatment initiation. Variables with UA values of P < 0.10 were included in MAs. Results: The median GTVSR was 51.1% (range, 9.8e86.8%). The median pretreatment Alb, AGR, CRP, CBV, BW and BMI were as follows: 3.7 g/dl (range, 2.5e4.7 g/dl), 1.2 (range, 0.5e1.7), 0.5 mg/dl (range, 0.1e10.4 mg/dl), 1552.3 cc (range, 962.8e2229.5 cc), 58.3 kg (range, 35.0e80.9 kg), and 20.7 kg/m2 (range, 12.9e28.8 kg/m2). In UAs, N0 stage (P Z 0.032), N1 stage (P Z 0.036), Alb (P Z 0.006), CBV (P Z 0.007), and BW (P Z 0.041) were significant. N2a stage (P Z 0.05), use of PEG (P Z 0.052), DTX-based menu (P Z 0.058), and BMI (P Z 0.05) were marginally significant. MAs revealed an association of higher pretreatment Alb with GTVSR (P Z 0.02; 95% confidence interval, 2.94e32.47). Conclusion: Higher pretreatment Alb was associated with greater GTVSR during curative EBRT. Assessing pretreatment Alb may be crucial for selecting optimal OSCC treatment strategy. Author Disclosure: K. Takeda: None. H. Matsushita: None. T. Ogawa: None. M. Kubozono: None. Y. Ishikawa: None. T. Yamamoto: None. M. Kozumi: None. N. Takahashi: None. S. Dobashi: None. N. Kadoya: None. K. Ito: None. M. Chiba: None. S. Komori: None. Y. Ishizawa: None. K. Takeda: None. S. Tasaka: None. Y. Katagiri: None. T. Tanabe: None. Y. Katori: None. K. Jingu: None.
2890 Relationship Between Radiation Therapy Dose and Overall Survival in Anaplastic Thyroid Cancer: Analysis of the National Cancer Data Base T.A. Pezzi,1 A.S.R. Mohamed,2 T. Sheu,2 P. Blanchard,2 V.C. Sandulache,3 S.Y. Lai,3 M.E. Cabanillas,4 M.D. Williams,5 C.M. Pezzi,6 C. Lu,7 A.S. Garden,2 W.H. Morrison,2 D.I. Rosenthal,2 C.D. Fuller,2 and G.B. Gunn2; 1Baylor College of Medicine, Houston, TX, 2The University of Texas MD Anderson Cancer Center, Division of Radiation Oncology, Houston, TX, 3Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 4 Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, 5 Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 6Department of Surgery, Abington Hospital-Jefferson Health, Abington, PA, 7Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX Purpose/Objective(s): A retrospective study of the National Cancer Data Base (NCDB) was conducted to explore the relationship between radiation therapy (RT) dose and overall survival (OS) in anaplastic thyroid cancer (ATC). Materials/Methods: Cases of ATC were identified in the NCDB and clinical variables extracted. Patients with tumors <1 cm were excluded. OS was compared by patient, tumor stage, and treatment groups of interest, including by neck RT dose. Those who received <45 Gy were considered to have received palliative intent RT and were excluded from dose-survival analyses. We considered those who received 60-75 Gy to have received higher therapeutic dose and those 45-59.9 Gy a lower potentially therapeutic dose. Correlates of OS were explored using univariate and subsequent multivariate analyses. Results: Of the 355,000 cases of thyroid malignancy registered in the NCDB from 1998-2012, 3,266 (0.92%) were ATC. Mean age was 70.2
years. 59.7% were women and 86.2% were white. 1,325 received (documented) RT to the neck. Of those, 468 (39.6%) received <45 Gy, 269 (22.7%) received 45-59.9 Gy, and 446 (37.7%) received 60-75 Gy. Patients who received 45-59.9 Gy vs. 60-75 Gy were older (68.7 vs. 66.7 years; P Z 0.029), more often had distant metastases (35.3% vs. 24.0%; P Z 0.001), and were less likely to have received primary site surgery (53.2% vs. 61.7%; P Z 0.025); there was no difference in the likelihood of having 1 comorbidities (79.3% vs. 79.2%; P Z 0.98), being N+ (50.9% vs. 47.1%; P Z 0.32), or receipt of chemotherapy (72.9% vs. 76.0%; P Z 0.35). Overall, those who had received 60-75 Gy had improved OS vs. those who had received 45-59.9 Gy (1- and 5-yr. OS rates were 43% and 15% vs. 27% and 9% respectively, with median OS of 9.8 vs. 5.6 mos respectively; P<0.0005). The best outcomes observed were for those with stage IVA/B who had received tri-modality therapy (surgery, chemotherapy, and RT) with higher dose neck RT (1- and 5-yr OS rates were 56% and 15% vs. 42% and 12%, for 60-75 Gy vs. 45-59.9 Gy respectively; P Z 0.02). This dose-survival relationship persisted for those IVA/IVB pts who had received no surgery (or subtotal [R2] resection) (1- and 5-yr OS rates were 36% and 9% vs. 21% and 9%; P Z 0.023). On multivariate analysis, age 65 yrs. (HR 1.37, CI: 1.19e1.58; P<0.0005), presence of 1 comorbidity (HR 1.37, CI: 1.18e 0.56; P<0.0005), N+ (HR 1.19, CI: 1.04e1.37; P Z 0.011), stage IVC (HR 1.83, CI: 1.57e2.13; P<0.0005), receipt of chemotherapy (HR 0.769, 0.67e0. 89; P<0.0005), receipt of surgery (HR 0.637, CI: 0.55e0.74; P<0.0005), and receipt of higher dose RT (60-75 Gy vs. 45e59.9 Gy; HR 0.72, CI: 0.60e0.88; P Z 0.001) correlated with OS. Conclusion: These results highlight the importance of identifying patients with ATC who benefit most from multi-modal local-regional treatment, incorporating higher dose neck RT. Author Disclosure: T.A. Pezzi: None. A.S. Mohamed: None. T. Sheu: None. P. Blanchard: None. V.C. Sandulache: None. S.Y. Lai: None. M.E. Cabanillas: None. M.D. Williams: None. C.M. Pezzi: None. C. Lu: None. A.S. Garden: None. W.H. Morrison: None. D.I. Rosenthal: None. C.D. Fuller: None. G.B. Gunn: None.
2891 Clinical Outcome of Intensity Modulated Radiation Therapy for Carcinoma Showing Thymus-like Differentiation F. Kong,1,2 H. Ying,1,2 R. Zhai,1,2 C. Du,1,2 S. Huang,1,2 J. Zhou,1,2 X. He,1,2 G. Zhu,1,2 C. Shen,1,2 and C. Hu1,2; 1Fudan University Shanghai Cancer Center, Shanghai, China, 2Shanghai Medical College, Fudan University, Shanghai, China Purpose/Objective(s): Carcinoma showing thymus-like differentiation (CASTLE) is a rare malignant tumor of the thyroid or adjacent soft tissue in the neck. There is no consensus on the management of this disease. The purpose of this study was to assess the clinical outcome of intensitymodulated radiation therapy (IMRT) combined with surgery for the treatment of CASTLE. Materials/Methods: We retrospectively reviewed 14 patients of this very rare neoplasm who were treated by postoperative IMRT in our institution between September 2008 and June 2015. The radiation doses ranged from 56Gy/28 fractions to 66Gy/33 fractions using simultaneous integrated boost (SIB) technique. Treatment-related toxicities were graded by National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 3.0. Results: The subjects consisted of six women and eight men. The median age was 48 years (range 38-60 years). Seven patients had lymph node metastasis. Tumor extension to adjacent organs was found in 9 patients. The common sites for tumor extending included the recurrent laryngeal nerve, muscles, esophagus, carotid artery and trachea. Toxicities related to IMRT were well tolerated (grade 1-2) and all patients completed radiation therapy as planned. After a median follow-up period of 42 months (range 7-92 months), only one patient suffered local recurrence and distant metastasis. No recurrence or metastasis was observed in the remaining patients. Conclusion: Adjuvant IMRT after surgery provides good local-regional control for patient with CASTLE. Curative IMRT may be an alternative for patients with unresectable disease. Long-term results are still needed.
Volume 96 Number 2S Supplement 2016 initial CT images. GTVSRs were calculated based on initial and re-planning CT images. Four patients (6%) received induction chemotherapy (IC). Fifty-seven patients (88%) received concurrent chemotherapy (CC) using following regimen: TPF [docetaxel (DTX), cisplatin (CDDP), and 5fluorouracil] (n Z 29, 44%); another CDDP-based menu (n Z 22, 34%); the other DTX-based menu (n Z 3, 5%); and cetuximab (n Z 3, 5%). Univariate analyses (UA) and multivariate analyses (MA) were performed to identify baseline factors related to the GTVSR. Potential variables include age, gender, T and N stage, use of IC, use of CC, CC menu, use of PEG, serum albumin (Alb), Alb globulin ratio (AGR), C-reactive protein (CRP), CBV, body weight (BW), and body mass index (BMI) before treatment initiation. Variables with UA values of P < 0.10 were included in MAs. Results: The median GTVSR was 51.1% (range, 9.8e86.8%). The median pretreatment Alb, AGR, CRP, CBV, BW and BMI were as follows: 3.7 g/dl (range, 2.5e4.7 g/dl), 1.2 (range, 0.5e1.7), 0.5 mg/dl (range, 0.1e10.4 mg/dl), 1552.3 cc (range, 962.8e2229.5 cc), 58.3 kg (range, 35.0e80.9 kg), and 20.7 kg/m2 (range, 12.9e28.8 kg/m2). In UAs, N0 stage (P Z 0.032), N1 stage (P Z 0.036), Alb (P Z 0.006), CBV (P Z 0.007), and BW (P Z 0.041) were significant. N2a stage (P Z 0.05), use of PEG (P Z 0.052), DTX-based menu (P Z 0.058), and BMI (P Z 0.05) were marginally significant. MAs revealed an association of higher pretreatment Alb with GTVSR (P Z 0.02; 95% confidence interval, 2.94e32.47). Conclusion: Higher pretreatment Alb was associated with greater GTVSR during curative EBRT. Assessing pretreatment Alb may be crucial for selecting optimal OSCC treatment strategy. Author Disclosure: K. Takeda: None. H. Matsushita: None. T. Ogawa: None. M. Kubozono: None. Y. Ishikawa: None. T. Yamamoto: None. M. Kozumi: None. N. Takahashi: None. S. Dobashi: None. N. Kadoya: None. K. Ito: None. M. Chiba: None. S. Komori: None. Y. Ishizawa: None. K. Takeda: None. S. Tasaka: None. Y. Katagiri: None. T. Tanabe: None. Y. Katori: None. K. Jingu: None.
2890 Relationship Between Radiation Therapy Dose and Overall Survival in Anaplastic Thyroid Cancer: Analysis of the National Cancer Data Base T.A. Pezzi,1 A.S.R. Mohamed,2 T. Sheu,2 P. Blanchard,2 V.C. Sandulache,3 S.Y. Lai,3 M.E. Cabanillas,4 M.D. Williams,5 C.M. Pezzi,6 C. Lu,7 A.S. Garden,2 W.H. Morrison,2 D.I. Rosenthal,2 C.D. Fuller,2 and G.B. Gunn2; 1Baylor College of Medicine, Houston, TX, 2The University of Texas MD Anderson Cancer Center, Division of Radiation Oncology, Houston, TX, 3Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 4 Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, 5 Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 6Department of Surgery, Abington Hospital-Jefferson Health, Abington, PA, 7Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX Purpose/Objective(s): A retrospective study of the National Cancer Data Base (NCDB) was conducted to explore the relationship between radiation therapy (RT) dose and overall survival (OS) in anaplastic thyroid cancer (ATC). Materials/Methods: Cases of ATC were identified in the NCDB and clinical variables extracted. Patients with tumors <1 cm were excluded. OS was compared by patient, tumor stage, and treatment groups of interest, including by neck RT dose. Those who received <45 Gy were considered to have received palliative intent RT and were excluded from dose-survival analyses. We considered those who received 60-75 Gy to have received higher therapeutic dose and those 45-59.9 Gy a lower potentially therapeutic dose. Correlates of OS were explored using univariate and subsequent multivariate analyses. Results: Of the 355,000 cases of thyroid malignancy registered in the NCDB from 1998-2012, 3,266 (0.92%) were ATC. Mean age was 70.2
years. 59.7% were women and 86.2% were white. 1,325 received (documented) RT to the neck. Of those, 468 (39.6%) received <45 Gy, 269 (22.7%) received 45-59.9 Gy, and 446 (37.7%) received 60-75 Gy. Patients who received 45-59.9 Gy vs. 60-75 Gy were older (68.7 vs. 66.7 years; P Z 0.029), more often had distant metastases (35.3% vs. 24.0%; P Z 0.001), and were less likely to have received primary site surgery (53.2% vs. 61.7%; P Z 0.025); there was no difference in the likelihood of having 1 comorbidities (79.3% vs. 79.2%; P Z 0.98), being N+ (50.9% vs. 47.1%; P Z 0.32), or receipt of chemotherapy (72.9% vs. 76.0%; P Z 0.35). Overall, those who had received 60-75 Gy had improved OS vs. those who had received 45-59.9 Gy (1- and 5-yr. OS rates were 43% and 15% vs. 27% and 9% respectively, with median OS of 9.8 vs. 5.6 mos respectively; P<0.0005). The best outcomes observed were for those with stage IVA/B who had received tri-modality therapy (surgery, chemotherapy, and RT) with higher dose neck RT (1- and 5-yr OS rates were 56% and 15% vs. 42% and 12%, for 60-75 Gy vs. 45-59.9 Gy respectively; P Z 0.02). This dose-survival relationship persisted for those IVA/IVB pts who had received no surgery (or subtotal [R2] resection) (1- and 5-yr OS rates were 36% and 9% vs. 21% and 9%; P Z 0.023). On multivariate analysis, age 65 yrs. (HR 1.37, CI: 1.19e1.58; P<0.0005), presence of 1 comorbidity (HR 1.37, CI: 1.18e 0.56; P<0.0005), N+ (HR 1.19, CI: 1.04e1.37; P Z 0.011), stage IVC (HR 1.83, CI: 1.57e2.13; P<0.0005), receipt of chemotherapy (HR 0.769, 0.67e0. 89; P<0.0005), receipt of surgery (HR 0.637, CI: 0.55e0.74; P<0.0005), and receipt of higher dose RT (60-75 Gy vs. 45e59.9 Gy; HR 0.72, CI: 0.60e0.88; P Z 0.001) correlated with OS. Conclusion: These results highlight the importance of identifying patients with ATC who benefit most from multi-modal local-regional treatment, incorporating higher dose neck RT. Author Disclosure: T.A. Pezzi: None. A.S. Mohamed: None. T. Sheu: None. P. Blanchard: None. V.C. Sandulache: None. S.Y. Lai: None. M.E. Cabanillas: None. M.D. Williams: None. C.M. Pezzi: None. C. Lu: None. A.S. Garden: None. W.H. Morrison: None. D.I. Rosenthal: None. C.D. Fuller: None. G.B. Gunn: None.
2891 Clinical Outcome of Intensity Modulated Radiation Therapy for Carcinoma Showing Thymus-like Differentiation F. Kong,1,2 H. Ying,1,2 R. Zhai,1,2 C. Du,1,2 S. Huang,1,2 J. Zhou,1,2 X. He,1,2 G. Zhu,1,2 C. Shen,1,2 and C. Hu1,2; 1Fudan University Shanghai Cancer Center, Shanghai, China, 2Shanghai Medical College, Fudan University, Shanghai, China Purpose/Objective(s): Carcinoma showing thymus-like differentiation (CASTLE) is a rare malignant tumor of the thyroid or adjacent soft tissue in the neck. There is no consensus on the management of this disease. The purpose of this study was to assess the clinical outcome of intensitymodulated radiation therapy (IMRT) combined with surgery for the treatment of CASTLE. Materials/Methods: We retrospectively reviewed 14 patients of this very rare neoplasm who were treated by postoperative IMRT in our institution between September 2008 and June 2015. The radiation doses ranged from 56Gy/28 fractions to 66Gy/33 fractions using simultaneous integrated boost (SIB) technique. Treatment-related toxicities were graded by National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 3.0. Results: The subjects consisted of six women and eight men. The median age was 48 years (range 38-60 years). Seven patients had lymph node metastasis. Tumor extension to adjacent organs was found in 9 patients. The common sites for tumor extending included the recurrent laryngeal nerve, muscles, esophagus, carotid artery and trachea. Toxicities related to IMRT were well tolerated (grade 1-2) and all patients completed radiation therapy as planned. After a median follow-up period of 42 months (range 7-92 months), only one patient suffered local recurrence and distant metastasis. No recurrence or metastasis was observed in the remaining patients. Conclusion: Adjuvant IMRT after surgery provides good local-regional control for patient with CASTLE. Curative IMRT may be an alternative for patients with unresectable disease. Long-term results are still needed.