Radiation Modality Utilization and Cardiopulmonary Mortality Risk in the Elderly with Esophageal Cancer

Details

• Alternative Title:
  Cancer
• Personal Author:
  Lin, Steven H. ; Zhang, Ning ; Godby, Joy ; Wang, Jingya ; Marsh, Gary D. ; Liao, Zhongxing ; Komaki, Ritsuko ; Ho, Linus ; Hofstetter, Wayne L. ; Swisher, Stephen G. ; Mehran, Reza J. ; Buchholz, Thomas A. ; Elting, Linda S. ; Giordano, Sharon H.
• Description:
  BACKGROUND
  
  It is currently unclear if the superior normal organ sparing effect of Intensity Modulated Radiation Therapy (IMRT) as compared to three-dimensional radiation therapy (3D) has clinical impact on survival and cardiopulmonary mortality in esophageal cancer (EC) patients.
  
  METHODS
  
  We identified 2,553 patients older than age 65 years from the SEER/Texas Cancer Registry-Medicare databases who had non-metastatic EC diagnosed between 2002 and 2009 and were treated with either 3D (n=2,240) or IMRT (n=313) within 6 months of diagnosis. The outcomes of the two cohorts were compared using Inverse Probability of Treatment Weighting (IPTW) adjustment.
  
  RESULTS
  
  Except for marital status, year of diagnosis, and SEER region, both radiation cohorts were well balanced for various patient, tumor, and treatment characteristics, including the use of IMRT vs. 3D in urban/metro or rural areas. IMRT use increased from 2.6% in 2002 to 30% in 2009, while 3D use decreased from 97.4% in 2002 to 70% in 2009. On propensity score IPTW-adjusted multivariate analysis, IMRT was not associated with EC-specific mortality (HR 0.93, 95%CI 0.80-1.10) or pulmonary mortality (HR 1.11, 95%CI 0.37-3.36) but was significantly associated with lower all-cause mortality (HR 0.83, 95%CI 0.72-0.95), cardiac mortality (HR 0.18, 95%CI 0.06-0.54) and other cause mortality (HR 0.54, 95%CI 0.35-0.84). Similar associations were seen after adjusting for the type of chemotherapy, physician experience, and sensitivity analysis removing hybrid radiation claims.
  
  CONCLUSIONS
  
  In this population-based analysis, IMRT use was significantly associated with lower all-cause mortality, cardiac mortality, and other-cause mortality in EC patients.
• Subjects:
  • Article
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases
  • Esophageal Neoplasms
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Lung Diseases
  • Male
  More +
• Source:
  Cancer. 122(6):917-928.
• Pubmed ID:
  26716915
• Pubmed Central ID:
  PMC6095128
• Document Type:
  Journal Article
• Funding:
  P30 CA016672/CA/NCI NIH HHS/United States ; U58 DP000824/DP/NCCDPHP CDC HHS/United States
• Place as Subject:
  Texas
• Volume:
  122
• Issue:
  6
• Download URL:
  https://stacks.cdc.gov/view/cdc/58187/cdc_58187_DS1.pdf
• File Type:
  [PDF - 502.38 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:7f319bc9e7e442b7ce02ddb651d2bb14463125b30eae3a73e2657c5cf8c1a783