13 research outputs found
The impact of positive margins on outcome among patients with gastric cancer treated with radiation.
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Patterns of care and outcomes of definitive external beam radiotherapy and radioembolization for localized hepatocellular carcinoma: A propensity score-adjusted analysis
329 Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality worldwide. Most patients with localized HCC are not surgically operable or transplantation candidates, thus there is an increasing role for nonsurgical locoregional therapies. Ablative external beam radiotherapy (XRT) and transarterial radioembolization (TARE) are two emerging radiotherapeutic treatments for localized HCC. However, there are little data comparing their efficacy. We therefore sought to evaluate their utilization and efficacy in a large nationwide cohort. Methods: We conducted an observational study of 2,685 patients from the National Cancer Database diagnosed with American Joint Committee on Cancer 7th edition clinical stage I-III HCC between 2004-2015, treated with definitive-intent XRT delivered in 1-15 fractions or TARE. The association between treatment modality (XRT versus TARE [referent]) and overall survival (OS) was defined using propensity score-weighted Kaplan-Meier estimators and propensity score-weighted multivariable Cox regressions. Results: Among 2,685 patients, 2,007 (74.7%) received TARE and 678 (25.3%) received XRT, with increasing usage for both from 2004-2015 ( Ptrend < 0.001), but with overall greater uptake and absolute usage of TARE. Patients who received TARE were more likely to have elevated alpha fetoprotein and more advanced stage ( P < 0.05 for all). Median OS was 14.5 months for the entire cohort. XRT was associated with an OS advantage compared to TARE on propensity score-unadjusted analysis (adjusted hazard ratio [AHR] 0.80, 95% CI 0.67-0.95, P = 0.013), but not on propensity score-adjusted analysis (AHR 0.93, 95% CI 0.76-1.14, P = 0.491). Conclusions: Our study demonstrates that while both XRT and TARE usage have increased with time, there was greater uptake and absolute use of TARE, especially in advanced disease. Nevertheless, we found no difference in survival between XRT and TARE after propensity score-adjustment. Given their equivalence on retrospective study, prospective trials are necessary