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Stage-Specific Survival Differences Associated with Postoperative Radiotherapy for Gastrointestinal Cancers

Journal of Gastrointestinal Cancer volume 39, pages 86–99 (2008)Cite this article

Abstract

Objective

To study the frequency and effect associated with postoperative radiotherapy (RT) for patients with resected gastrointestinal (GI) cancers.

Materials and Methods

In observational cohort from the Surveillance, Epidemiology, and End Results (SEER) program, a total of 23,049 patients were identified with resected pancreatic, gastric, esophageal, or rectal carcinomas diagnosed from 1988 to 2003. Using a propensity score analysis, survival differences associated with postoperative RT were analyzed.

Results

Adjuvant RT was given to 51.2%, 26.3%, 33.0%, and 58.0% of pancreatic, gastric, esophageal, and rectal cancer patients, respectively. Age and stage of disease were associated with RT use for each site (P < 0.001), with younger patients and those with advanced disease receiving RT more frequently. Postoperative RT was associated with a survival benefit for patients with pancreatic cancer (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.79–0.96), gastric cancer (HR, 0.93; 95% CI, 0.87–0.99), and rectal cancer (HR, 0.84; 95% CI, 0.79–0.90). Subgroups of patients were also identified who experienced the greatest improvement in survival with RT (stage IIB pancreatic cancer, HR = 0.71 [95% CI 0.62–0.80]; stage IIIA and IV gastric cancer, HR = 0.86 [95% CI 0.77–0.97] and HR = 0.77 [95% CI 0.67–0.89], respectively; stages IIA, IIIB, and IIIC rectal cancer, HR = 0.87 [95% CI 0.78–0.97], HR = 0.71 [95% CI 0.63–0.80], and HR = 0.79 [95% CI 0.70–0.90], respectively).

Conclusion

Postoperative RT is associated with improved survival for patients who undergo curative resection of pancreatic, gastric, and rectal malignancies. Significant differences are observed for this effect according to stage of disease, with more advanced cases in general experiencing a greater benefit with RT.

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Abbreviations

AJCC:

American Joint Committee on Cancer

CI:

confidence interval

GI:

gastrointestinal

NCCN:

National Comprehensive Cancer Network

RT:

radiotherapy

SEER:

Surveillance, Epidemiology, and End Results

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Acknowledgements

No significant sources of funding were used in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. All authors report no conflicts of interest or financial disclosures.

Author information

Affiliations

  1. Department of Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA

    John S. Moody, Stephen M. Sawrie & James A. Bonner

  2. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

    Kevin R. Kozak

  3. Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    John P. Plastaras

  4. Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA

    George Howard

  5. 105 Wallace Tumor Institute, 1530 3rd Ave S, Birmingham, AL, 35294–3300, USA

    James A. Bonner

Authors
  1. John S. Moody
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  2. Stephen M. Sawrie
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  3. Kevin R. Kozak
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  4. John P. Plastaras
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  5. George Howard
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  6. James A. Bonner
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Correspondence to James A. Bonner.

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Moody, J.S., Sawrie, S.M., Kozak, K.R. et al. Stage-Specific Survival Differences Associated with Postoperative Radiotherapy for Gastrointestinal Cancers. J Gastrointest Canc 39, 86–99 (2008). https://doi.org/10.1007/s12029-009-9053-3

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  • DOI: https://doi.org/10.1007/s12029-009-9053-3

Keywords

  • radiotherapy
  • SEER
  • adjuvant treatment
  • survival analyses