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. 2016 Mar 15;122(6):917-28.
doi: 10.1002/cncr.29857. Epub 2015 Dec 30.

Radiation modality use and cardiopulmonary mortality risk in elderly patients with esophageal cancer

Steven H Lin  1 , Ning Zhang  2 , Joy Godby  1 , Jingya Wang  1 , Gary D Marsh  1 , Zhongxing Liao  1 , Ritsuko Komaki  1 , Linus Ho  3 , Wayne L Hofstetter  4 , Stephen G Swisher  4 , Reza J Mehran  4 , Thomas A Buchholz  1 , Linda S Elting  2 , Sharon H Giordano  2
Affiliations

Radiation modality use and cardiopulmonary mortality risk in elderly patients with esophageal cancer

Steven H Lin et al. Cancer. .

Abstract

Background: It is currently unclear whether the superior normal organ-sparing effect of intensity-modulated radiotherapy (IMRT) compared with 3-dimensional radiotherapy (3D) has a clinical impact on survival and cardiopulmonary mortality in patients with esophageal cancer (EC).

Methods: The authors identified 2553 patients aged > 65 years from the Surveillance, Epidemiology, and End Results (SEER)-Medicare and Texas Cancer Registry-Medicare databases who had nonmetastatic EC diagnosed between 2002 and 2009 and were treated with either 3D (2240 patients) or IMRT (313 patients) within 6 months of diagnosis. The outcomes of the 2 cohorts were compared using inverse probability of treatment weighting adjustment.

Results: Except for marital status, year of diagnosis, and SEER region, both radiation cohorts were well balanced with regard to various patient, tumor, and treatment characteristics, including the use of IMRT versus 3D in urban/metropolitan or rural areas. IMRT use increased from 2.6% in 2002 to 30% in 2009, whereas the use of 3D decreased from 97.4% in 2002 to 70% in 2009. On propensity score inverse probability of treatment weighting-adjusted multivariate analysis, IMRT was not found to be associated with EC-specific mortality (hazard ratio [HR], 0.93; 95% confidence interval [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 noted after adjusting for the type of chemotherapy, physician experience, and sensitivity analysis removing hybrid radiation claims.

Conclusions: In this population-based analysis, the use of IMRT was found to be significantly associated with lower all-cause mortality, cardiac mortality, and other-cause mortality in patients with EC.

Keywords: 3-dimensional conformal radiotherapy; Epidemiology; Surveillance; and End Results (SEER); cardiopulmonary mortality; esophageal cancer; intensity-modulated radiotherapy (IMRT); propensity score.

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Conflict of interest statement

Conflict of Interest: No potential conflicts of interest were disclosed by the other authors.

Figures

Figure 1
Figure 1
The utilization of 3D and IMRT for the treatment of EC from 2002 to 2009.
Figure 2
Figure 2
IPTW-adjusted overall survival and cause-specific survival of patients treated with 3D versus IMRT. P value is by log-rank testing.
See this image and copyright information in PMC

Comment in

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