Adjuvant radiation for positive margins in adult head and neck sarcomas is associated with improved survival : Analysis of the National Cancer Database
Abstract Background Adult head and neck (H&N) sarcomas are a rare malignancy with limited data delineating the role of postoperative radiotherapy (PORT), particularly for a positive surgical margin. There are no randomized trials supporting the use of PORT, therefore treatment trends vary between institutions. A positive margin predicts recurrence and poor survival outcomes. This study uses the National Cancer Database (NCDB) to investigate whether PORT improves overall survival (OS) in adult H&N sarcomas with a positive margin and how utilization has changed. Methods Patients ( n = 1142) in the NCDB from 2004‐2013 with adult H&N sarcomas who underwent resection and had a positive margin. Results Factors significantly associated with increased utilization of PORT were: having insurance, salivary gland primary site, high‐risk histology, poor differentiation, and a macroscopic positive margin. Treatment with PORT was associated with improved 5‐year OS for all patients with a positive margin (57% vs 48%; P = .002), both microscopic (57% vs 49%; P = .010) and macroscopic (57% vs 41%; P = .036). Improved OS was significant after controlling for other known covariates on multivariate analysis (HR: 0.76; [0.64‐0.90]; P = .002). Treatment at a community‐based facility was an independent predictor for reduced OS (HR: 1.37; [1.15‐1.64]; P < .001). The percentage utilization (53%) of PORT for these patients did not change significantly over time. Conclusion PORT provides a significant survival benefit for adult H&N sarcoma patients with either a microscopic or macroscopic positive margin; however, PORT is underutilized. Treatment at academic/research cancer programs was associated with increased utilization of PORT and improved survival outcomes..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:41 |
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| Enthalten in: |
Head & Neck - 41(2019), 6, Seite 1873-1879 |
| Beteiligte Personen: |
Cannon, Richard B. [VerfasserIn] |
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| BKL: |
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| Anmerkungen: |
© 2019 Wiley Periodicals, Inc. |
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| Umfang: |
7 |
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| doi: |
10.1002/hed.25619 |
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WLY006990061 |
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| 245 | 1 | 0 | |a Adjuvant radiation for positive margins in adult head and neck sarcomas is associated with improved survival |b Analysis of the National Cancer Database |
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| 520 | |a Abstract Background Adult head and neck (H&N) sarcomas are a rare malignancy with limited data delineating the role of postoperative radiotherapy (PORT), particularly for a positive surgical margin. There are no randomized trials supporting the use of PORT, therefore treatment trends vary between institutions. A positive margin predicts recurrence and poor survival outcomes. This study uses the National Cancer Database (NCDB) to investigate whether PORT improves overall survival (OS) in adult H&N sarcomas with a positive margin and how utilization has changed. Methods Patients ( n = 1142) in the NCDB from 2004‐2013 with adult H&N sarcomas who underwent resection and had a positive margin. Results Factors significantly associated with increased utilization of PORT were: having insurance, salivary gland primary site, high‐risk histology, poor differentiation, and a macroscopic positive margin. Treatment with PORT was associated with improved 5‐year OS for all patients with a positive margin (57% vs 48%; P = .002), both microscopic (57% vs 49%; P = .010) and macroscopic (57% vs 41%; P = .036). Improved OS was significant after controlling for other known covariates on multivariate analysis (HR: 0.76; [0.64‐0.90]; P = .002). Treatment at a community‐based facility was an independent predictor for reduced OS (HR: 1.37; [1.15‐1.64]; P < .001). The percentage utilization (53%) of PORT for these patients did not change significantly over time. Conclusion PORT provides a significant survival benefit for adult H&N sarcoma patients with either a microscopic or macroscopic positive margin; however, PORT is underutilized. Treatment at academic/research cancer programs was associated with increased utilization of PORT and improved survival outcomes. | ||
| 700 | 1 | |a Kull, Amanda J. |4 aut | |
| 700 | 1 | |a Carpenter, Patrick S. |4 aut | |
| 700 | 1 | |a Francis, Sam |4 aut | |
| 700 | 1 | |a Buchmann, Luke O. |4 aut | |
| 700 | 1 | |a Monroe, Marcus M. |4 aut | |
| 700 | 1 | |a Lloyd, Shane |4 aut | |
| 700 | 1 | |a Hitchcock, Ying J. |4 aut | |
| 700 | 1 | |a Cannon, Donald |4 aut | |
| 700 | 1 | |a Weis, John R. |4 aut | |
| 700 | 1 | |a Houlton, Jeffrey J. |4 aut | |
| 700 | 1 | |a Hunt, Jason P. |4 aut | |
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