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Aggressive Supportive Care Improves Outcomes in the Combined Modality Treatment of Pancreatic and Duodenal Cancer
I. J. Radiation Oncology d Biology d Physics
S278
2138
Volume 69, Number 3, Supplement, 2007
Preliminary Report of PCS Results of Radiotherapy for the Esophageal Cancer in South Korea: Comparative Analysis With Results of the United States and Japan
W. Hur1, Y. Choi1, H. Lee1, I. Kim2, H. Lee3, K. Lee4, J. Kim5, M. Chun6, J. Kim7, Y. Ahn8, et al. 1
Dong-A University Hospital, Busan, Republic of Korea, 2Seoul National University Hospital, Seoul, Republic of Korea, Maryknoll Hospital, Busan, Republic of Korea, 4Gacjon Gil Hospital, Incheon, Republic of Korea, 5Chonbuk National University Hospital, Jeonju, Republic of Korea, 6Ajou University Hospital, Suwon, Republic of Korea, 7Keimyung University Hospital, Daegu, Republic of Korea, 8Sungkyunkwan University Hospital, Seoul, Republic of Korea 3
Purpose/Objective(s): For the first time, a nationwide PCS of esophageal cancer was performed in South Korea and the results will be published soon. We compared the Korean results with those from the United States and Japan to see the different parameters and to offer a solid cooperative system among three countries. Materials/Methods: Two hundreds and forty-six patients of esophageal cancer from twenty one institutions were enrolled in South Korea. They received radiotherapy (RT) between 1998 and 1999 and were confirmed as having epithelial cancer with no distant metastasis and without any double primary. In the United States, 414 patients from 59 institutions who received RT between 1996–1999 were chosen and in Japan, 220 patients from 78 facilities between 1998 and 2001 were enrolled. Results: The median age of the entire patients was 62 years in Korea, 64 years in US and 62.3 years in Japan. Male to female ratio was 91:9 in Korea, 77:23 in US and 88:12 in Japan. Ninety-six percent of Korean patients and 99.5% of Japanese patients were confirmed as squamous cell carcinomas, but in US, it shows almost equal prevalence between adenocarcinoma (49.6%) and squamous cell ca (48.7%). Most frequently used evaluative procedures were esophagogram (92.7%: Korea, 64%: US, 97.2%: Japan), esophagoscopy (91.9%: Korea, 95.6%: US, 88.7%: Japan) and chest CT (96.7%: Korea, 86.8%: US, 97.0%: Japan). Endoscopic ultrasonography was used less frequently in all three countries (17.5%: Korea, 3.5%: US, 23.6%: Japan). Clinical Stages according to the 1983 AJCC staging system revealed that 44.1% was in stage I and II in Korea, 40.6% in US and 59% in Japan. Treatment modalities were analyzed in different ways among 3 countries. In Korean PCS, it shows that the most frequently used treatment modality combined with RT was chemotherapy (CTx) (50.0%) followed by surgery (26.8%). In US study, the percentage of CTx combined with RT was 70.5% (RT+CTx: 52%, preop RT+CTx: 10.4%, postop RT+CTx: 8.1%), RT alone was used 22.8% and the rest 6.6% was combined with surgery only. In Japanese PCS, 97.3% of patients who received RT underwent surgery (preop RT: 26.3%, postop RT: 66%, both pre- and postop RT: 5%). The combination CTx of 5-FU and cisplatin was the most commonly scheme used in Korea (81.8%). In US study, of all CTx given patients, 5-FU was used in 82%, cisplantin 67% and paclitaxel 22%. Japanese study shows that 5-FU was used in 78.2% and cisplantin in 76.5%. When combined with CTx, concurrent CTxRT was most frequently used in all three countries (Korea 56.9%, US 97%, Japan 59.7%). Korean PCS shows that the median delivered dose of radiation for the patients who received surgery was 50.4 Gy and that of no surgery was 59.4 Gy. Only the total median delivered dose was analyzed in US (50.4 Gy) and Japanese Study (48 Gy). Thirty-eight percent of patients underwent CTbased planning in Korea, 54% in US but not investigated in Japan. Brachytherapy was used for the 12.3% of the entire patients in Korea, 6% of cases in US as a means of boosting the primary sites. Conclusions: Although some aspects of evaluation for the esophageal cancer and it’s treatment modalities were heterogenous among three countries, but there was no differences in the frequency of use of chemoradiation, chemotherapeutic agents and delivered RT dose. Author Disclosure: W. Hur, None; Y. Choi, None; H. Lee, None; I. Kim, None; H. Lee, None; K. Lee, None; J. Kim, None; M. Chun, None; J. Kim, None; Y. Ahn, None.
2139
Aggressive Supportive Care Improves Outcomes in the Combined Modality Treatment of Pancreatic and Duodenal Cancer
V. C. Wilson1, K. Claghorn1, M. Guo1, M. Hampshire1, P. O’Dwyer1, W. Sun1, J. Drebin1, E. Rosato1, R. Whittington2, J. M. Metz1 1
Hospital of the University of Pennsylvania, Philadelphia, PA, 2Veterans Affairs Medical Center, Philadelphia, PA
Purpose/Objective(s): Many patients who present for treatment of pancreatic and duodenal cancers have significant nutritional deficiencies, weight loss, and malabsorption issues. Aggressive intervention with nutritional support and counseling, along with fluid hydration, may help patients better tolerate a full course of combined modality therapy (CMT) and improve outcomes. This retrospective study was performed to evaluate the implementation of aggressive supportive care measures during radiation therapy for pancreatic and duodenal cancers. Materials/Methods: Between 7/99–7/05, 76 patients with pancreatic (n = 69) and duodenal cancer (n = 7) were treated with radiation therapy at the Hospital of the University of Pennsylvania. The median age was 58.5 yrs (range = 45–78). The population consisted of 52 males (68%) and 64 were Caucasian (84%). Of the 79 patients, 32 (42%) received postoperative radiation therapy, 42 (55%) received definitive radiation therapy, and 2 (3%) were treated preoperatively. The patients were Stage I (1%), Stage II (30%), and Stage III (68%). Concurrent 5FU based chemotherapy was given in 73 (96%). A policy of aggressive nutritional counseling and support and home intravenous fluid hydration was instituted over the period of this study. Patients were compared between those that received this aggressive supportive care regimen (ASC) and those who received standard radiation therapy (SRT) with supportive care based on presentation of symptoms. Results: Of the 76 patients, 47 (62%) had ASC and 29 (38%) had SRT. The average age was 57 years for ASC and 61 years for SRT (p = 0.063). The median dose delivered was 54 Gy for ASC vs. 50 Gy for SRT. There was no significant difference in the number of patients that underwent surgical resection between the two groups (p = .2). For those that received ASC, 29 (62%) were maintained on daily intravenous infusions through treatment. The mean change in weight over the duration of radiation treatment was 10 lbs for ASC and 13.3 lbs for SRT (p = 0.15). The median number of missed radiation treatment days was 0 for ASC vs. 9 for SRT (p \ 0.001). While 94% of the ASC completed CMT on schedule, 10% in the SRT arm completed CMT on schedule. The median survival time for resected patients was 1032 days for ASC vs. 335 days for SRT (p\0.001). The median survival time for unresectable patients was 517 days for ASC vs. 221 days for SRT (p \ 0.001). Conclusions: Aggressive early supportive care reduced treatment breaks and improved clinical outcomes in pancreatic and duodenal cancers in this retrospective study. Significant planning and support are needed to develop a program of ASC. Future
Proceedings of the 49th Annual ASTRO Meeting
S279
prospective clinical trials should define aggressive supportive care measures to better compare outcomes both within and between trials. Author Disclosure: V.C. Wilson, None; K. Claghorn, None; M. Guo, None; M. Hampshire, None; P. O’Dwyer, None; W. Sun, None; J. Drebin, None; E. Rosato, None; R. Whittington, None; J.M. Metz, None.
2140
Adjuvant Radiotherapy Demonstrates Improved Survival for Locoregional Extrahepatic Cholangiocarcinoma (EHCC): A Population-Based Analysis
C. D. Fuller1, C. R. Thomas2, S. J. Wang2 1
Univ. of Texas Health Science Center-San Antonio, San Antonio, TX, 2Oregon Health and Science University, Portland, OR
Purpose/Objective(s): Cholangiocarcinomas are comparatively rare gastrointestinal neoplasms, and, while full extirpation is the mainstay of treatment, most patients present with locally advanced disease. Owing in part to numerical rarity, the optimum role of radiotherapy for EHCC remains an area of debate. The specific aim of this series is to derive baseline survival for EHCC patients receiving adjuvant radiotherapy, evaluated against comparative treatment cohorts, using a robust population based dataset. Materials/Methods: A total 2591 cases of local or regional EHCC diagnosed between 1973–1998 were extracted from the Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat (Apr 2006 Release) of the National Cancer Institute. Cases were extracted by matching morphology and site codes based on the method described by Welzel et al. Cases were sorted using JMP statistical analysis software into the following treatment cohorts: surgery alone (S), radiotherapy alone (RT), surgery and radiotherapy (S+RT) and no surgery/radiotherapy recorded (NS/NRT). Patients with unstaged or distant disease by Historic SEER Staging were excluded. Survival was calculated with product-limit methodology, with univariate and multivariate analysis by using treatment cohort as a covariate for Cox proportional hazard modeling. Multivariate modeling also included literature-derived prognostic variables (Age .65, Local vs. Regional disease, and Pathologic Grade). Results: Overall locoregional EHCC median survival was 9 months. A statistically significant survival differential was observed between treatment groups (Table 1, Wilcoxon p # 0.001). Both univariate and multivariate proportional hazards analysis revealed a statistically significant whole-model log-likelihood (p \ 0.001) with effect likelihood ratio test p # 0.001 for all included covariates. Univariate relative risk (RR) is shown in Table 1, normalized to the S treatment group. Multivariate Cox model derived relative risk (RR) estimates normalized to S (RR = 1) showed a statistically significant survival advantage for S+RT (RR 0.73, CI 0.69–0.77); by contrast RT (RR 1.14, CI 1.06–1.24) and NS/NRT (RR 1.56, CI 1.49–1.64) showed a greater association with mortality. Conclusions: Survival estimates using SEER data suggest a possible survival advantage for adjuvant radiotherapy for locoregional EHCC compared to single modality (S or RT) regimens. While confirmatory series are required to validate these observations, SEER data represents the largest extant domestic population-based EHCC dataset, and may provide useful baseline survival estimates for prospective studies. Median (95% CI) and mean survival in months; univariate relative risk (CI) by treatment cohort Cohort
n
Median (95% CI)
Mean
RR (CI)
All NS/NRT RT S S+RT
2591 997 416 857 321
9 (9–10) 4 (3–4) 11 (10–12) 14 (13–16) 18 (16–21)
25.7 11.3 16.8 41.4 33.6
— 1.62 (1.55–1.70) 1.23 (1.13–1.33) 1 (–) 0.72 (0.68–0.76)
Author Disclosure: C.D. Fuller, None; C.R. Thomas, None; S.J. Wang, None.
2141
Outcomes of Adjuvant Chemoradiation Following Pancreaticoduodenectomy With Mesenterico-portal Vein Resection for Adenocarcinoma of the Pancreas
B. Hristov1, S. H. Lin1, J. L. Cameron2, J. M. Herman1, T. J. Pawlik2, R. H. Hruban3, M. J. Swartz1, S. Edil2, C. Kemp2, C. L. Wolfgang2 1 Department of Radiation Oncology and Molecular Radiation Sciences, 2Department of Surgery, 3Department of Pathology, Johns Hopkins University, Baltimore, MD
Purpose/Objective(s): The purpose of this study is to compare outcomes between pancreaticoduodenectomy (PD) with and without mesenterico-portal vein resection (VR) in patients who received adjuvant chemoradiation (CRT) for adenocarcinoma of the pancreas. Materials/Methods: 908 patients underwent a curative PD for adenocarcinoma of the pancreas between 1993 and 2005. 41 patients underwent PD with VR and of these, 20 received 5FU-based adjuvant CRT followed by maintenance chemotherapy. For a PD to be considered a PD with VR, resection of a portion of the mesenterico-portal vasculature with primary closure was required. These patients were compared to a group of 140 patients who received 5FU-based CRT following PD without VR. Clinical outcomes, including surgical and CRT complication rates, were assessed for both groups of patients. A significant complication as a result of adjuvant CRT was defined as any of the following: weight loss $10 kg during treatment, unplanned treatment breaks, and treatment-related hospitalizations. The median follow-up was 20.4 mos (6–153 mos). Median survival and 2-year overall survival (OS) rates were calculated using the Kaplan-Meier method and compared by the log-rank test. Results: The two patient groups were similar in terms of median age, race/gender distribution, and median radiation (RT) dose received (table). There was no statistically significant difference between the two groups with regard to nodal or margin status
S278
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Volume 69, Number 3, Supplement, 2007
Preliminary Report of PCS Results of Radiotherapy for the Esophageal Cancer in South Korea: Comparative Analysis With Results of the United States and Japan
W. Hur1, Y. Choi1, H. Lee1, I. Kim2, H. Lee3, K. Lee4, J. Kim5, M. Chun6, J. Kim7, Y. Ahn8, et al. 1
Dong-A University Hospital, Busan, Republic of Korea, 2Seoul National University Hospital, Seoul, Republic of Korea, Maryknoll Hospital, Busan, Republic of Korea, 4Gacjon Gil Hospital, Incheon, Republic of Korea, 5Chonbuk National University Hospital, Jeonju, Republic of Korea, 6Ajou University Hospital, Suwon, Republic of Korea, 7Keimyung University Hospital, Daegu, Republic of Korea, 8Sungkyunkwan University Hospital, Seoul, Republic of Korea 3
Purpose/Objective(s): For the first time, a nationwide PCS of esophageal cancer was performed in South Korea and the results will be published soon. We compared the Korean results with those from the United States and Japan to see the different parameters and to offer a solid cooperative system among three countries. Materials/Methods: Two hundreds and forty-six patients of esophageal cancer from twenty one institutions were enrolled in South Korea. They received radiotherapy (RT) between 1998 and 1999 and were confirmed as having epithelial cancer with no distant metastasis and without any double primary. In the United States, 414 patients from 59 institutions who received RT between 1996–1999 were chosen and in Japan, 220 patients from 78 facilities between 1998 and 2001 were enrolled. Results: The median age of the entire patients was 62 years in Korea, 64 years in US and 62.3 years in Japan. Male to female ratio was 91:9 in Korea, 77:23 in US and 88:12 in Japan. Ninety-six percent of Korean patients and 99.5% of Japanese patients were confirmed as squamous cell carcinomas, but in US, it shows almost equal prevalence between adenocarcinoma (49.6%) and squamous cell ca (48.7%). Most frequently used evaluative procedures were esophagogram (92.7%: Korea, 64%: US, 97.2%: Japan), esophagoscopy (91.9%: Korea, 95.6%: US, 88.7%: Japan) and chest CT (96.7%: Korea, 86.8%: US, 97.0%: Japan). Endoscopic ultrasonography was used less frequently in all three countries (17.5%: Korea, 3.5%: US, 23.6%: Japan). Clinical Stages according to the 1983 AJCC staging system revealed that 44.1% was in stage I and II in Korea, 40.6% in US and 59% in Japan. Treatment modalities were analyzed in different ways among 3 countries. In Korean PCS, it shows that the most frequently used treatment modality combined with RT was chemotherapy (CTx) (50.0%) followed by surgery (26.8%). In US study, the percentage of CTx combined with RT was 70.5% (RT+CTx: 52%, preop RT+CTx: 10.4%, postop RT+CTx: 8.1%), RT alone was used 22.8% and the rest 6.6% was combined with surgery only. In Japanese PCS, 97.3% of patients who received RT underwent surgery (preop RT: 26.3%, postop RT: 66%, both pre- and postop RT: 5%). The combination CTx of 5-FU and cisplatin was the most commonly scheme used in Korea (81.8%). In US study, of all CTx given patients, 5-FU was used in 82%, cisplantin 67% and paclitaxel 22%. Japanese study shows that 5-FU was used in 78.2% and cisplantin in 76.5%. When combined with CTx, concurrent CTxRT was most frequently used in all three countries (Korea 56.9%, US 97%, Japan 59.7%). Korean PCS shows that the median delivered dose of radiation for the patients who received surgery was 50.4 Gy and that of no surgery was 59.4 Gy. Only the total median delivered dose was analyzed in US (50.4 Gy) and Japanese Study (48 Gy). Thirty-eight percent of patients underwent CTbased planning in Korea, 54% in US but not investigated in Japan. Brachytherapy was used for the 12.3% of the entire patients in Korea, 6% of cases in US as a means of boosting the primary sites. Conclusions: Although some aspects of evaluation for the esophageal cancer and it’s treatment modalities were heterogenous among three countries, but there was no differences in the frequency of use of chemoradiation, chemotherapeutic agents and delivered RT dose. Author Disclosure: W. Hur, None; Y. Choi, None; H. Lee, None; I. Kim, None; H. Lee, None; K. Lee, None; J. Kim, None; M. Chun, None; J. Kim, None; Y. Ahn, None.
2139
Aggressive Supportive Care Improves Outcomes in the Combined Modality Treatment of Pancreatic and Duodenal Cancer
V. C. Wilson1, K. Claghorn1, M. Guo1, M. Hampshire1, P. O’Dwyer1, W. Sun1, J. Drebin1, E. Rosato1, R. Whittington2, J. M. Metz1 1
Hospital of the University of Pennsylvania, Philadelphia, PA, 2Veterans Affairs Medical Center, Philadelphia, PA
Purpose/Objective(s): Many patients who present for treatment of pancreatic and duodenal cancers have significant nutritional deficiencies, weight loss, and malabsorption issues. Aggressive intervention with nutritional support and counseling, along with fluid hydration, may help patients better tolerate a full course of combined modality therapy (CMT) and improve outcomes. This retrospective study was performed to evaluate the implementation of aggressive supportive care measures during radiation therapy for pancreatic and duodenal cancers. Materials/Methods: Between 7/99–7/05, 76 patients with pancreatic (n = 69) and duodenal cancer (n = 7) were treated with radiation therapy at the Hospital of the University of Pennsylvania. The median age was 58.5 yrs (range = 45–78). The population consisted of 52 males (68%) and 64 were Caucasian (84%). Of the 79 patients, 32 (42%) received postoperative radiation therapy, 42 (55%) received definitive radiation therapy, and 2 (3%) were treated preoperatively. The patients were Stage I (1%), Stage II (30%), and Stage III (68%). Concurrent 5FU based chemotherapy was given in 73 (96%). A policy of aggressive nutritional counseling and support and home intravenous fluid hydration was instituted over the period of this study. Patients were compared between those that received this aggressive supportive care regimen (ASC) and those who received standard radiation therapy (SRT) with supportive care based on presentation of symptoms. Results: Of the 76 patients, 47 (62%) had ASC and 29 (38%) had SRT. The average age was 57 years for ASC and 61 years for SRT (p = 0.063). The median dose delivered was 54 Gy for ASC vs. 50 Gy for SRT. There was no significant difference in the number of patients that underwent surgical resection between the two groups (p = .2). For those that received ASC, 29 (62%) were maintained on daily intravenous infusions through treatment. The mean change in weight over the duration of radiation treatment was 10 lbs for ASC and 13.3 lbs for SRT (p = 0.15). The median number of missed radiation treatment days was 0 for ASC vs. 9 for SRT (p \ 0.001). While 94% of the ASC completed CMT on schedule, 10% in the SRT arm completed CMT on schedule. The median survival time for resected patients was 1032 days for ASC vs. 335 days for SRT (p\0.001). The median survival time for unresectable patients was 517 days for ASC vs. 221 days for SRT (p \ 0.001). Conclusions: Aggressive early supportive care reduced treatment breaks and improved clinical outcomes in pancreatic and duodenal cancers in this retrospective study. Significant planning and support are needed to develop a program of ASC. Future
Proceedings of the 49th Annual ASTRO Meeting
S279
prospective clinical trials should define aggressive supportive care measures to better compare outcomes both within and between trials. Author Disclosure: V.C. Wilson, None; K. Claghorn, None; M. Guo, None; M. Hampshire, None; P. O’Dwyer, None; W. Sun, None; J. Drebin, None; E. Rosato, None; R. Whittington, None; J.M. Metz, None.
2140
Adjuvant Radiotherapy Demonstrates Improved Survival for Locoregional Extrahepatic Cholangiocarcinoma (EHCC): A Population-Based Analysis
C. D. Fuller1, C. R. Thomas2, S. J. Wang2 1
Univ. of Texas Health Science Center-San Antonio, San Antonio, TX, 2Oregon Health and Science University, Portland, OR
Purpose/Objective(s): Cholangiocarcinomas are comparatively rare gastrointestinal neoplasms, and, while full extirpation is the mainstay of treatment, most patients present with locally advanced disease. Owing in part to numerical rarity, the optimum role of radiotherapy for EHCC remains an area of debate. The specific aim of this series is to derive baseline survival for EHCC patients receiving adjuvant radiotherapy, evaluated against comparative treatment cohorts, using a robust population based dataset. Materials/Methods: A total 2591 cases of local or regional EHCC diagnosed between 1973–1998 were extracted from the Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat (Apr 2006 Release) of the National Cancer Institute. Cases were extracted by matching morphology and site codes based on the method described by Welzel et al. Cases were sorted using JMP statistical analysis software into the following treatment cohorts: surgery alone (S), radiotherapy alone (RT), surgery and radiotherapy (S+RT) and no surgery/radiotherapy recorded (NS/NRT). Patients with unstaged or distant disease by Historic SEER Staging were excluded. Survival was calculated with product-limit methodology, with univariate and multivariate analysis by using treatment cohort as a covariate for Cox proportional hazard modeling. Multivariate modeling also included literature-derived prognostic variables (Age .65, Local vs. Regional disease, and Pathologic Grade). Results: Overall locoregional EHCC median survival was 9 months. A statistically significant survival differential was observed between treatment groups (Table 1, Wilcoxon p # 0.001). Both univariate and multivariate proportional hazards analysis revealed a statistically significant whole-model log-likelihood (p \ 0.001) with effect likelihood ratio test p # 0.001 for all included covariates. Univariate relative risk (RR) is shown in Table 1, normalized to the S treatment group. Multivariate Cox model derived relative risk (RR) estimates normalized to S (RR = 1) showed a statistically significant survival advantage for S+RT (RR 0.73, CI 0.69–0.77); by contrast RT (RR 1.14, CI 1.06–1.24) and NS/NRT (RR 1.56, CI 1.49–1.64) showed a greater association with mortality. Conclusions: Survival estimates using SEER data suggest a possible survival advantage for adjuvant radiotherapy for locoregional EHCC compared to single modality (S or RT) regimens. While confirmatory series are required to validate these observations, SEER data represents the largest extant domestic population-based EHCC dataset, and may provide useful baseline survival estimates for prospective studies. Median (95% CI) and mean survival in months; univariate relative risk (CI) by treatment cohort Cohort
n
Median (95% CI)
Mean
RR (CI)
All NS/NRT RT S S+RT
2591 997 416 857 321
9 (9–10) 4 (3–4) 11 (10–12) 14 (13–16) 18 (16–21)
25.7 11.3 16.8 41.4 33.6
— 1.62 (1.55–1.70) 1.23 (1.13–1.33) 1 (–) 0.72 (0.68–0.76)
Author Disclosure: C.D. Fuller, None; C.R. Thomas, None; S.J. Wang, None.
2141
Outcomes of Adjuvant Chemoradiation Following Pancreaticoduodenectomy With Mesenterico-portal Vein Resection for Adenocarcinoma of the Pancreas
B. Hristov1, S. H. Lin1, J. L. Cameron2, J. M. Herman1, T. J. Pawlik2, R. H. Hruban3, M. J. Swartz1, S. Edil2, C. Kemp2, C. L. Wolfgang2 1 Department of Radiation Oncology and Molecular Radiation Sciences, 2Department of Surgery, 3Department of Pathology, Johns Hopkins University, Baltimore, MD
Purpose/Objective(s): The purpose of this study is to compare outcomes between pancreaticoduodenectomy (PD) with and without mesenterico-portal vein resection (VR) in patients who received adjuvant chemoradiation (CRT) for adenocarcinoma of the pancreas. Materials/Methods: 908 patients underwent a curative PD for adenocarcinoma of the pancreas between 1993 and 2005. 41 patients underwent PD with VR and of these, 20 received 5FU-based adjuvant CRT followed by maintenance chemotherapy. For a PD to be considered a PD with VR, resection of a portion of the mesenterico-portal vasculature with primary closure was required. These patients were compared to a group of 140 patients who received 5FU-based CRT following PD without VR. Clinical outcomes, including surgical and CRT complication rates, were assessed for both groups of patients. A significant complication as a result of adjuvant CRT was defined as any of the following: weight loss $10 kg during treatment, unplanned treatment breaks, and treatment-related hospitalizations. The median follow-up was 20.4 mos (6–153 mos). Median survival and 2-year overall survival (OS) rates were calculated using the Kaplan-Meier method and compared by the log-rank test. Results: The two patient groups were similar in terms of median age, race/gender distribution, and median radiation (RT) dose received (table). There was no statistically significant difference between the two groups with regard to nodal or margin status