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Race and the Risk of Death Following High-Dose Radiation Therapy in Men Treated With or Without Androgen Suppression Therapy for Favorable-Risk Prostate Cancer
E402
International Journal of Radiation Oncology Biology Physics
The dataset was interrogated for demographic information, diagnosis, treatment modality, referral patterns, and clinical trial involvement for all patients. Cases were classified as simple (easy immobilization, 2 treatment fields) or complex (difficult immobilization or 3 treatment fields). Additionally, the total volume of photon patients treated in our department was collected between January 2011 and December 2015 to evaluate the impact of PT on our photon patient volume. Results: A total of 278 patients were treated with PT during the study period, including 228 (82%) adults and 50 (18%) pediatric (PED) cases. PT patients traveled a mean distance of 83.3 miles compared to 47.4 miles traveled by photon patients queried in 2015. Rationale for treatment included retreatment in a previously irradiated volume (20%), involvement in prospective clinical trial (14%), and proximity to critical structures to maximally spare organs at risk (66%). Forty patients were enrolled on 5 adult and 3 PED prospective clinical trials evaluating PT. The most common adult histologies treated were glioma (27%) and nonsmall cell lung cancer (18%). Prostate cancer comprised 6% of PT. PED patients comprised 18% of all cases, with the most common diagnoses being medulloblastoma (22%) and low-grade glioma (24%). Complex treatment cases comprised 45% of our institutional volume, including 38 PED and 87 adult cases. Our photon patient volume increased yearly between 2011 and 2015, with 2,780 patients completing photon treatment in 2011 and 3,385 patients in 2015. Patients treated with PT comprised 4% of overall patients treated with external beam radiation. Within our system, this project is meeting our initial projections and is financially viable. Conclusion: The inauguration of our single gantry proton center has doubled our geographical reach, added to our overall patient volume, and has allowed us to offer patients therapeutic options previously not available in our region. Based on our initial 2-year experience, installation of a second PT unit is being considered. Author Disclosure: J. Contreras: None. T. Zhao: None. S.M. Perkins: None. B. Sun: None. S. Goddu: None. S. Mutic: Honoraria; Viewray, Varian Medical Systems. Travel Expenses; Siemens Healthcare. Stock; Radiologica. Partnership; TreatSafely, LLC. Responsible for the technical direction of the company; Radialogica, LLC. Responsible for general management of the organization and all aspects of the business; TreatSafely, LLC. B.A. Bottani: None. S. Endicott: None. J.M. Michalski: Employee; Sheila Michalski. Research Grant; NCI. Co-principal investigator; Veterans Affairs. Board Member; National Children’s Cancer Society. Chair Radiation Oncology Committee; NRG Oncology. C.G. Robinson: Research Grant; Elekta. Speaker’s Bureau; Varian Medical Systems. Advisory Board; Radialogica. Stock Options; Radialogica. C.I. Tsien: Honoraria; Merck. Vice Chair; RSNA. J. Huang: Speaker’s Bureau; Viewray Inc. D.E. Hallahan: Stock; Cumberland Pharmaceuticals. Chief Radiation Oncology; BJH medical center. J.D. Bradley: Employee; Washington University. Research Grant; Mevion Medical Systems, ViewRay Inc. Proton Therapy Advisory Board; Varian Medical. Lung Cancer Committee chair; NRG Oncology.
that race had on the risk of all and other cause mortality (ACM, OCM) amongst men treated with brachytherapy with or without neoadjuvant ADT for favorable-risk prostate cancer (PC). Materials/Methods: Between 1997 and 2013, 7252 men with low or favorable-intermediate PC were treated with brachytherapy with (n Z 1501) or without (n Z 5751) neoadjuvant ADT of 4-month median duration. Cox and Fine and Grays multivariable regression were used to analyze whether the risk of ACM and OCM were increased amongst AA versus non-AA men receiving ADT adjusting for age at and year of brachytherapy, cardiometabolic comorbidity, risk group and an ADT treatment propensity score. Results: After a median follow-up of 8.04 years, 869 (12.0%) men died, 48 (5.52%) of PC and 821 (94.48%) of other causes. There was a significant association between AA race and an increased risk of both ACM (Adjusted Hazard Ratio (AHR) 1.77; 95% Confidence Interval (CI) 1.06-2.95; P Z 0.028) and OCM (AHR 1.86; 95% CI 1.09-3.20; P Z 0.024) among AA men as compared to non-AA men who received ADT but not among those who did not receive ADT (ACM: AHR 1.33; 95% CI, 0.93-1.91; P Z 0.12; OCM: AHR 1.39; 95% CI, 0.96-2.02; P Z 0.08). Conclusion: Given the increased risk of death among AA men with low or favorable-intermediate-risk PC receiving short course neoadjuvant ADT, ADT should be reserved for treatment of higher-risk PC in AA men where level one evidence supports its use. Author Disclosure: K. Kovtun: None. M. Chen: None. M.H. Braccioforte: None. B.J. Moran: None. A.V. D’Amico: None.
2990 Race and the Risk of Death Following High-Dose Radiation Therapy in Men Treated With or Without Androgen Suppression Therapy for Favorable-Risk Prostate Cancer K. Kovtun,1,2 M.H. Chen,3 M.H. Braccioforte,4 B.J. Moran,4 and A.V. D’Amico5; 1Beth Israel Deaconess Medical Center, Boston, MA, 2 Harvard Radiation Oncology Program, Boston, MA, 3University of Connecticut, Storrs, CT, 4Prostate Cancer Foundation of Chicago, Westmont, IL, 5Dana Farber Cancer Institute and Brigham & Women’s Hospital, Boston, MA Purpose/Objective(s): African American (AA) men are more likely than non-AA men to have comorbid illness that may interact with androgen deprivation therapy (ADT) and shorten survival. We assessed the impact
2991 The Influence of Insurance Policy on Radiation Oncology Physician Stereotactic Body Radiation Therapy/Stereotactic Ablative Radiation Therapy Use Practices: A North American Survey H. Kim,1 I. Kalchman,1 T. Dan,1 T. Zhan,2 and M. Werner-Wasik1; 1Sidney Kimmel Medical College at Thomas Jefferson University, Sidney Kimmel Cancer Center, Philadelphia, PA, 2Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA Purpose/Objective(s): European data indicate that 8 fraction stereotactic body radiation therapy (SBRT) is similar in efficacy but safer than 5 fraction SBRT for central lung lesions. However, SBRT in the United States (US) continues to only be reimbursed for precisely delivered high dose external beam radiation therapy of up to 5 fractions. Our hypothesis was that SBRT insurance policy limits the clinical investigation and utilization of 5 fraction SBRT in the US compared to Canada. Materials/Methods: In January 2016, a 15 question electronic survey was distributed to radiation oncologists at National Cancer Institute designated cancer centers in the US (60) and the ten highest research funded cancer centers in Canada (6). Centers without practicing radiation oncologists were excluded. Fisher exact test (or exact logistic regression if applicable) was used, where P<0.05 was considered statistically different from neutral. Results: 107 (13.1%) radiation oncologists completed the survey. The most common fractionation regimens amongst each disease category was: 18 Gy x 3 for peripheral lung (30.8%), 10 Gy x 5 for central/chest wall lung (51.4%), 7.25 Gy x 5 prostate (58.3%), 6.6 Gy x 5 for pancreas (40.9%) and 10 Gy x 5 for liver (41.1%) tumors. Sixty-one percent of US radiation oncologists indicate that there are instances where they would like to prescribe >5 fraction SBRT but prescribe 5 fractions due to insurance reimbursement (P Z .11). In contrast, 100% of Canadian radiation oncologists (P Z .038) report they never are influenced by insurance policy to prescribe >5 fraction SBRT (comparison to US, P Z .001). Fifty percent of Canadian radiation oncologists commonly prescribe 7.5 Gy x 8 for central lung lesions, whereas only 25.8% of US radiation oncologists commonly use this regimen (P Z .14). US radiation oncologists report that SBRT clinical investigation is constrained by the insurance reimbursement
International Journal of Radiation Oncology Biology Physics
The dataset was interrogated for demographic information, diagnosis, treatment modality, referral patterns, and clinical trial involvement for all patients. Cases were classified as simple (easy immobilization, 2 treatment fields) or complex (difficult immobilization or 3 treatment fields). Additionally, the total volume of photon patients treated in our department was collected between January 2011 and December 2015 to evaluate the impact of PT on our photon patient volume. Results: A total of 278 patients were treated with PT during the study period, including 228 (82%) adults and 50 (18%) pediatric (PED) cases. PT patients traveled a mean distance of 83.3 miles compared to 47.4 miles traveled by photon patients queried in 2015. Rationale for treatment included retreatment in a previously irradiated volume (20%), involvement in prospective clinical trial (14%), and proximity to critical structures to maximally spare organs at risk (66%). Forty patients were enrolled on 5 adult and 3 PED prospective clinical trials evaluating PT. The most common adult histologies treated were glioma (27%) and nonsmall cell lung cancer (18%). Prostate cancer comprised 6% of PT. PED patients comprised 18% of all cases, with the most common diagnoses being medulloblastoma (22%) and low-grade glioma (24%). Complex treatment cases comprised 45% of our institutional volume, including 38 PED and 87 adult cases. Our photon patient volume increased yearly between 2011 and 2015, with 2,780 patients completing photon treatment in 2011 and 3,385 patients in 2015. Patients treated with PT comprised 4% of overall patients treated with external beam radiation. Within our system, this project is meeting our initial projections and is financially viable. Conclusion: The inauguration of our single gantry proton center has doubled our geographical reach, added to our overall patient volume, and has allowed us to offer patients therapeutic options previously not available in our region. Based on our initial 2-year experience, installation of a second PT unit is being considered. Author Disclosure: J. Contreras: None. T. Zhao: None. S.M. Perkins: None. B. Sun: None. S. Goddu: None. S. Mutic: Honoraria; Viewray, Varian Medical Systems. Travel Expenses; Siemens Healthcare. Stock; Radiologica. Partnership; TreatSafely, LLC. Responsible for the technical direction of the company; Radialogica, LLC. Responsible for general management of the organization and all aspects of the business; TreatSafely, LLC. B.A. Bottani: None. S. Endicott: None. J.M. Michalski: Employee; Sheila Michalski. Research Grant; NCI. Co-principal investigator; Veterans Affairs. Board Member; National Children’s Cancer Society. Chair Radiation Oncology Committee; NRG Oncology. C.G. Robinson: Research Grant; Elekta. Speaker’s Bureau; Varian Medical Systems. Advisory Board; Radialogica. Stock Options; Radialogica. C.I. Tsien: Honoraria; Merck. Vice Chair; RSNA. J. Huang: Speaker’s Bureau; Viewray Inc. D.E. Hallahan: Stock; Cumberland Pharmaceuticals. Chief Radiation Oncology; BJH medical center. J.D. Bradley: Employee; Washington University. Research Grant; Mevion Medical Systems, ViewRay Inc. Proton Therapy Advisory Board; Varian Medical. Lung Cancer Committee chair; NRG Oncology.
that race had on the risk of all and other cause mortality (ACM, OCM) amongst men treated with brachytherapy with or without neoadjuvant ADT for favorable-risk prostate cancer (PC). Materials/Methods: Between 1997 and 2013, 7252 men with low or favorable-intermediate PC were treated with brachytherapy with (n Z 1501) or without (n Z 5751) neoadjuvant ADT of 4-month median duration. Cox and Fine and Grays multivariable regression were used to analyze whether the risk of ACM and OCM were increased amongst AA versus non-AA men receiving ADT adjusting for age at and year of brachytherapy, cardiometabolic comorbidity, risk group and an ADT treatment propensity score. Results: After a median follow-up of 8.04 years, 869 (12.0%) men died, 48 (5.52%) of PC and 821 (94.48%) of other causes. There was a significant association between AA race and an increased risk of both ACM (Adjusted Hazard Ratio (AHR) 1.77; 95% Confidence Interval (CI) 1.06-2.95; P Z 0.028) and OCM (AHR 1.86; 95% CI 1.09-3.20; P Z 0.024) among AA men as compared to non-AA men who received ADT but not among those who did not receive ADT (ACM: AHR 1.33; 95% CI, 0.93-1.91; P Z 0.12; OCM: AHR 1.39; 95% CI, 0.96-2.02; P Z 0.08). Conclusion: Given the increased risk of death among AA men with low or favorable-intermediate-risk PC receiving short course neoadjuvant ADT, ADT should be reserved for treatment of higher-risk PC in AA men where level one evidence supports its use. Author Disclosure: K. Kovtun: None. M. Chen: None. M.H. Braccioforte: None. B.J. Moran: None. A.V. D’Amico: None.
2990 Race and the Risk of Death Following High-Dose Radiation Therapy in Men Treated With or Without Androgen Suppression Therapy for Favorable-Risk Prostate Cancer K. Kovtun,1,2 M.H. Chen,3 M.H. Braccioforte,4 B.J. Moran,4 and A.V. D’Amico5; 1Beth Israel Deaconess Medical Center, Boston, MA, 2 Harvard Radiation Oncology Program, Boston, MA, 3University of Connecticut, Storrs, CT, 4Prostate Cancer Foundation of Chicago, Westmont, IL, 5Dana Farber Cancer Institute and Brigham & Women’s Hospital, Boston, MA Purpose/Objective(s): African American (AA) men are more likely than non-AA men to have comorbid illness that may interact with androgen deprivation therapy (ADT) and shorten survival. We assessed the impact
2991 The Influence of Insurance Policy on Radiation Oncology Physician Stereotactic Body Radiation Therapy/Stereotactic Ablative Radiation Therapy Use Practices: A North American Survey H. Kim,1 I. Kalchman,1 T. Dan,1 T. Zhan,2 and M. Werner-Wasik1; 1Sidney Kimmel Medical College at Thomas Jefferson University, Sidney Kimmel Cancer Center, Philadelphia, PA, 2Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA Purpose/Objective(s): European data indicate that 8 fraction stereotactic body radiation therapy (SBRT) is similar in efficacy but safer than 5 fraction SBRT for central lung lesions. However, SBRT in the United States (US) continues to only be reimbursed for precisely delivered high dose external beam radiation therapy of up to 5 fractions. Our hypothesis was that SBRT insurance policy limits the clinical investigation and utilization of 5 fraction SBRT in the US compared to Canada. Materials/Methods: In January 2016, a 15 question electronic survey was distributed to radiation oncologists at National Cancer Institute designated cancer centers in the US (60) and the ten highest research funded cancer centers in Canada (6). Centers without practicing radiation oncologists were excluded. Fisher exact test (or exact logistic regression if applicable) was used, where P<0.05 was considered statistically different from neutral. Results: 107 (13.1%) radiation oncologists completed the survey. The most common fractionation regimens amongst each disease category was: 18 Gy x 3 for peripheral lung (30.8%), 10 Gy x 5 for central/chest wall lung (51.4%), 7.25 Gy x 5 prostate (58.3%), 6.6 Gy x 5 for pancreas (40.9%) and 10 Gy x 5 for liver (41.1%) tumors. Sixty-one percent of US radiation oncologists indicate that there are instances where they would like to prescribe >5 fraction SBRT but prescribe 5 fractions due to insurance reimbursement (P Z .11). In contrast, 100% of Canadian radiation oncologists (P Z .038) report they never are influenced by insurance policy to prescribe >5 fraction SBRT (comparison to US, P Z .001). Fifty percent of Canadian radiation oncologists commonly prescribe 7.5 Gy x 8 for central lung lesions, whereas only 25.8% of US radiation oncologists commonly use this regimen (P Z .14). US radiation oncologists report that SBRT clinical investigation is constrained by the insurance reimbursement