Postoperative Radiation for Pathologic Stage T4 Colon Cancers Receiving Adjuvant Chemotherapy.
Adenocarcinoma
/ mortality
Aged
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Chemoradiotherapy, Adjuvant
/ methods
Colectomy
Colon
/ pathology
Colonic Neoplasms
/ mortality
Female
Humans
Male
Margins of Excision
Middle Aged
Neoplasm Staging
Radiotherapy Dosage
Registries
/ statistics & numerical data
Retrospective Studies
Survival Analysis
Treatment Outcome
Surgical margins
Survival
Journal
Clinical colorectal cancer
ISSN: 1938-0674
Titre abrégé: Clin Colorectal Cancer
Pays: United States
ID NLM: 101120693
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
01
11
2018
revised:
18
02
2019
accepted:
08
04
2019
pubmed:
18
5
2019
medline:
7
7
2020
entrez:
18
5
2019
Statut:
ppublish
Résumé
Previous small retrospective studies have suggested a benefit, mainly in preventing local recurrence, for postoperative radiation in nonmetastatic pathologic stage T4 colon cancers in patients who did not receive adjuvant chemotherapy. Current guidelines recommend postoperative radiation in nonmetastatic T4 colon cancers with penetration to a fixed structure, as well as for all patients with positive surgical margins. We aimed to assess the survival benefit of postoperative radiation in individuals with T4 colon cancers who received adjuvant chemotherapy. Using the National Cancer Data Base (2004-2014), we identified 20,967 and 5882 individuals with nonmetastatic pathologic stage T4 colon cancer treated with adjuvant chemotherapy who had negative or positive surgical margins, respectively. We used multivariate Cox regression to evaluate the effect of postoperative radiation on overall survival. In a secondary analysis, we stratified individuals according to chemotherapy intensity, pathologic N stage, and primary tumor location. Postoperative radiation did not improve overall survival in individuals with positive surgical margins (hazard ratio = 1.05 [95% CI, 0.96-1.16]). This lack of survival benefit was noted regardless of chemotherapy regimen used, with adjusted hazard ratios of 1.11 (95% CI, 0.94-1.31) and 0.96 (0.85-1.09) for single-agent and doublet chemotherapy, respectively. Similarly, pathologic N stage and primary tumor location did not affect survival. In individuals with negative surgical margins, there was a detrimental effect for postoperative radiation, with an adjusted hazard ratio of 1.19 (95% CI, 1.10-1.29). Postoperative radiation did not improve overall survival in individuals with pathologic stage T4 colon cancer who had either negative or positive surgical margins and who received adjuvant chemotherapy.
Sections du résumé
BACKGROUND
Previous small retrospective studies have suggested a benefit, mainly in preventing local recurrence, for postoperative radiation in nonmetastatic pathologic stage T4 colon cancers in patients who did not receive adjuvant chemotherapy. Current guidelines recommend postoperative radiation in nonmetastatic T4 colon cancers with penetration to a fixed structure, as well as for all patients with positive surgical margins. We aimed to assess the survival benefit of postoperative radiation in individuals with T4 colon cancers who received adjuvant chemotherapy.
METHODS
Using the National Cancer Data Base (2004-2014), we identified 20,967 and 5882 individuals with nonmetastatic pathologic stage T4 colon cancer treated with adjuvant chemotherapy who had negative or positive surgical margins, respectively. We used multivariate Cox regression to evaluate the effect of postoperative radiation on overall survival. In a secondary analysis, we stratified individuals according to chemotherapy intensity, pathologic N stage, and primary tumor location.
RESULTS
Postoperative radiation did not improve overall survival in individuals with positive surgical margins (hazard ratio = 1.05 [95% CI, 0.96-1.16]). This lack of survival benefit was noted regardless of chemotherapy regimen used, with adjusted hazard ratios of 1.11 (95% CI, 0.94-1.31) and 0.96 (0.85-1.09) for single-agent and doublet chemotherapy, respectively. Similarly, pathologic N stage and primary tumor location did not affect survival. In individuals with negative surgical margins, there was a detrimental effect for postoperative radiation, with an adjusted hazard ratio of 1.19 (95% CI, 1.10-1.29).
CONCLUSION
Postoperative radiation did not improve overall survival in individuals with pathologic stage T4 colon cancer who had either negative or positive surgical margins and who received adjuvant chemotherapy.
Identifiants
pubmed: 31097386
pii: S1533-0028(18)30520-6
doi: 10.1016/j.clcc.2019.04.004
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
226-230.e2Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.