Chia Chin Li

Does higher radiation dose lead to better outcome for non-operated localized esophageal squamous cell carcinoma patients who received concurrent chemoradiotherapy? A population based propensity-score matched analysis

BACKGROUND The optimal radiotherapy dose for non-operated localized esophageal squamous cell carcinoma (NOL-ESCC) patients undergoing concurrent chemoradiotherapy (CCRT) is hotly debated. METHODS We identified eligible patients diagnosed within 2008-2013 from Taiwan Cancer Registry and constructed a propensity score matched cohort (1:1 for high dose (⩾60Gy) vs standard dose (50-50.4Gy)) to balance observable potential confounders. We compared the hazard ratio (HR) of death between standard and high radiotherapy dose groups during the entire follow-up period. We performed sensitivity analysis (SA) to evaluate the robustness of our finding regarding potential unobserved confounders & index date definition. RESULTS Our study population constituted 648 patients with well balance in observed co-variables. The HR of death when high dose was compared to standard dose was 0.75 (95% confidence interval 0.64-0.88). Our result was sensitive to potential unobserved confounders but robust to alternative index date definition in SA. CONCLUSIONS We found that higher than standard radiotherapy dose may lead to better survival for NOL-ESCC patients undergoing CCRT.

Cost‐effectiveness of neoadjuvant concurrent chemoradiotherapy versus esophagectomy for locally advanced esophageal squamous cell carcinoma: A population‐based matched case‐control study

Neoadjuvant concurrent chemoradiotherapy (NCCRT) is often considered for locally‐advanced esophageal squamous cell carcinoma (LA‐ESCC) patients; however, no data regarding the cost‐effectiveness of this treatment is available. Our study aimed to evaluate the cost‐effectiveness of NCCRT versus esophagectomy for LA‐ESCC at population level.

A Population-Based Study of the Effectiveness of Stereotactic Ablative Radiotherapy Versus Conventional Fractionated Radiotherapy for Clinical Stage I Non-Small Cell Lung Cancer Patients

Abstract Background Stereotactic ablative radiotherapy (SABR) is a promising option for non-operated early-stage non-small cell lung cancer (NSCLC) compared to conventional fractionated radiotherapy (CFRT). However, results from conclusive randomized controlled trials are not yet available. The aim of our study was to explore the effectiveness of SABR vs. CFRT for non-operated early-stage NSCLC. Patients and methods We used a comprehensive population-based database to identify clinical stage I non-operated NSCLC patients in Taiwan diagnosed from 2007 to 2013 who were treated with either SABR or CFRT. We used inverse probability weighting and the propensity score as the primary form of analysis to address the nonrandomization of treatment. In the supplementary analyses, we constructed subgroups based on propensity score matching to compare survival between patients treated with SABR vs. CFRT. Results We identified 238 patients in our primary analysis. A good balance of covariates was achieved using the propensity score weighting. Overall survival (OS) was not significantly different between those treated with SABR vs. CFRT (SABR vs. CFRT: probability weighting adjusted hazard ratio [HR] 0.586, 95% confidence interval 0.264–1.101, p = 0.102). However, SABR was significantly favored in supplementary analyses. Conclusions In this population-based propensity-score adjusted analysis, we found that OS was not significantly different between those treated with SABR vs. CFRT in the primary analysis, although significance was observed in the supplementary analyses. Our results should be interpreted with caution given the database (i.e., nonrandomized) approach used in our study. Overall, further studies are required to explore these issues.

Questionable role of adjuvant chemotherapy in rectal cancer patients who had reached pathological complete response after neoadjuvant concurrent chemoradiotherapy: no matter in the East or in the West

approved by Research ethics Committee (CMUh103ReC-005), we identified 891 newly diagnosed (in 2007– 2010) American Joint Committee on Cancer clinical stage II–III rectal adenocarcinoma cancer patients who received neoadjuvant concurrent systemic therapy and conventional fractionated radiotherapy. Among those 852 patients received radical R0 resection, 74 reached pCR. twenty-five of them receiving adjuvant systemic therapy (group A), whereas forty-nine (group B) did not. After median follow-up 12 months (range 6–49), the overall survival (OS) and disease-free survival (DFS) were similar between these two groups (p value 0.47 for OS and 0.5 for DFS) (Fig. 1a, b). After adjusted for potential covariables (including age, gender, clinical stage, type of operation and radiation dose) according to the literatures and our experience (Geva et al. 2014; Capirci et al. 2008; Ke et al. 2014), there were also no statistical difference between these two groups in Cox proportional hazard model. In the era of personalized medicine (Chien and Shih 2013), we believe these data to the editors,

Comparison of intensity-modulated radiotherapy vs 3-dimensional conformal radiotherapy for patients with non-metastatic esophageal squamous cell carcinoma receiving definitive concurrent chemoradiotherapy

Abstract Whether the survival outcome of patients with non-metastatic esophageal squamous cell carcinoma (NM-ESCC) receiving definitive concurrent chemoradiotherapy (CCRT) is better with intensity-modulated radiotherapy (IMRT) or with 3-dimensional conformal radiotherapy (3DCRT) has been debated in the literature. We designed this population-based propensity-score (PS)-matched analysis to address this question. We identified eligible patients diagnosed between 2008 and 2015 from the Taiwan Cancer Registry and constructed a PS-matched cohort (1:1 for IMRT vs 3DCRT) to balance observable potential confounders. We compared the hazard ratio (HR) of death between IMRT and 3DCRT during the entire follow-up period. We also evaluated freedom from local regional recurrence (FFLRR) and esophageal cancer-specific survival (ECSS). Sensitivity analyses (SA) were performed to examine the robustness of our findings. Our study population constituted 558 patients who were well balanced with regard to the measured covariables. The HR of death with IMRT compared to 3DCRT was 0.43 (95% confidence interval 0.35–0.52, P < .001). The results remained significant for FFLRR and ECSS. In SA, our results remained significant when additional covariables were taken into consideration. The survival outcome of patients with NM-ESCC receiving CCRT might be better with IMRT vs 3DCRT. These study results should be interpreted with caution given some possible covariates lacking in the registry. Further studies are needed to clarify this issue.

Effectiveness of tomotherapy vs linear accelerator image-guided intensity-modulated radiotherapy for localized pharyngeal cancer treated with definitive concurrent chemoradiotherapy: a Taiwanese population-based propensity score-matched analysis

OBJECTIVE This study used a population-based propensity score (PS)-matched analysis to compare the effectiveness of tomotherapy-based image-guided intensity-modulated radiotherapy (referred to as T-IMRT) with that of linear accelerator based (referred to as L-IMRT) for clinically localized pharyngeal cancer (LPC, divided into nasopharyngeal cancer and non-nasopharyngeal cancer) with definitive concurrent chemoradiotherapy (CCRT). METHODS Eligible LPC patients diagnosed between 2007 and 2014 were identified among all citizens in Taiwan from the Health and Welfare Data Science Center database. A PS-matched sample based on the PS estimated from the covariables of interest was constructed to compare the effectiveness of T-IMRT with L-IMRT. In the primary analysis, overall survival (OS) was compared for assessment of effectiveness. We also evaluated freedom from local regional recurrence and pharyngeal cancer-specific survival and performed supplementary analyses. RESULTS The study population included 960 patients equally divided into two groups. OS did not differ significantly between the T-IMRT and L-IMRT groups (hazard ratio for death: 0.82, p = 0.15, 5-year OS rate: 79 and 74% for T-IMRT and L-IMRT, respectively), and there were no significant differences in the other endpoints or supplementary analyses. CONCLUSION For LPC patients treated with definitive CCRT, we found no significant difference in disease control or survival between the T-IMRT and L-IMRT groups. However, further studies, especially randomized trials or studies focusing on other dimensions, such as quality of life, are needed. Advances in knowledge: We provide the first population-based study, as well as the largest study, on the clinical effectiveness of T-IMRT compared with L-IMRT in conjunction with CCRT in LPC patients.

Optimal interval of surgery after neoadjuvant radiochemotherapy in T3-4/N0+ rectal cancer: population level evidence in addition to controlled trial

We congratulated the study by Saglam et al. from Turkey (1) for providing efficacy data regarding optimal interval of surgery after neoadjuvant radiochemotherapy in locally advanced rectal cancer. However, what seen in controlled trial (efficacy) might not be seen in population real practice (effectiveness) (2). To our knowledge, this issue still remained controversial (3) and there was only one population level study from the Netherlands (4). Therefore, we would like to provide supplementary population level evidence from Taiwan.