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Article ; Online: Potential Implications of the New USMLE Step 1 Pass/Fail Format for Diversity Within Radiation Oncology

Bismarck Odei, MD / Prajnan Das, MD, MS, MPH / Chelsea Pinnix, MD, PhD / Raju Raval, MD, DPhil / Emma B. Holliday, MD

Advances in Radiation Oncology, Vol 6, Iss 1, Pp 100524- (2021)

2021

Keywords	Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Contemporary use and outcomes of radiation and chemotherapy for unresectable pancreatic cancer

Shalini Moningi / Xiudong Lei / Penny Fang / Cullen M. Taniguchi / Emma B. Holliday / Eugene J. Koay / Albert C. Koong / Ethan B. Ludmir / Bruce D. Minsky / Prajnan Das / Sharon H. Giordano / Grace L. Smith

Clinical and Translational Radiation Oncology, Vol 35, Iss , Pp 9-

2022 Volume 16

Abstract: Background: We assessed radiation treatment (RT) use and complications for unresectable pancreatic cancer in the US, comparing conventionally fractionated (CFRT) and stereotactic body radiation treatment (SBRT) to inform real-world expected outcomes and ... ...

Abstract	Background: We assessed radiation treatment (RT) use and complications for unresectable pancreatic cancer in the US, comparing conventionally fractionated (CFRT) and stereotactic body radiation treatment (SBRT) to inform real-world expected outcomes and practice. Material and Methods: We analyzed 5,624 patients with non-metastatic, unresectable pancreatic cancer (2,522 older patients age > 65, diagnosed 2006–2013 in Medicare linked data; and 3,102 younger patients age < 65, diagnosed 2006–2016 in MarketScan data), comparing CFRT vs. SBRT vs. chemotherapy alone. Cochran-Armitage tested temporal trends. Fisher’s Exact Test and proportional hazards models compared gastrointestinal (GI) complications. Healthcare payments (Consumer Price Index adjusted to 2015) through 12 months were compared using generalized linear regression models with log link and gamma distribution. Results: RT use declined from 55% to 45% of older patients (2006–2013) and 52% to 47% of younger patients (2006–2016) (Ptrend < 0.001 both). Among RT patients, SBRT use increased to 10% of older patients and 12% of younger patients in the most recent years (Ptrend = 0.04 and < 0.001 respectively). Addition of RT was associated with more frequent GI bleeds, strictures, and fistulas (Δ= +3% to 9% excess events, all P ≤ 0.05). Temporal patterns suggested decreasing complications over time (Ptrend = 0.05 and 0.05 for older and younger patients). Among younger patients, there was no difference in GI complications for SBRT vs. CFRT (P > 0.05, all comparisons). Among older patients, increased complications were seen for SBRT in 1–4 fractions vs. CFRT (P < 0.05), but not SBRT in 5 fractions (P = 0.72). Healthcare payments were greatest for SBRT when compared with CFRT or chemotherapy under US Medicare (P < 0.001) and employer-based insurance (P < 0.001). Conclusion: Real-world treatment has shifted toward more selectivity for RT in unresectable pancreatic cancer. However, SBRT uptake and improving trends in complications profiles ...
Keywords	Pancreatic cancer ; Stereotactic body radiation treatment ; SBRT ; Complications ; Toxicity ; Gastrointestinal ; Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Subject code	610
Language	English
Publishing date	2022-07-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Patient-Reported Outcomes After Chemoradiation in Patients With Anal Cancer

Kelsey L. Corrigan, MD, MPH / Brian De, MD / Michael K. Rooney, MD / Ethan B. Ludmir, MD / Prajnan Das, MD, MS, MPH / Grace L. Smith, MD, PhD / Cullen M. Taniguchi, MD, PhD / Bruce D. Minsky, MD / Eugene J. Koay, MD, PhD / Albert C. Koong, MD, PhD / Emma B. Holliday, MD

Advances in Radiation Oncology, Vol 7, Iss 4, Pp 100986- (2022)

A Qualitative Analysis

2022

Abstract: Purpose: Pelvic chemoradiation therapy (CRT) is the curative therapy for non-metastatic anal cancer, resulting in excellent survival rates. However, anal cancer survivors may experience diminished quality of life (QOL) due to late toxicities from pelvic ... ...

Abstract	Purpose: Pelvic chemoradiation therapy (CRT) is the curative therapy for non-metastatic anal cancer, resulting in excellent survival rates. However, anal cancer survivors may experience diminished quality of life (QOL) due to late toxicities from pelvic CRT. Few studies use patient-reported QOL, and few include thematic analyses of the patient experience in their own words. We conducted a survey study with qualitative analysis of free-text responses to explore themes of patient perceptions of their QOL during and after pelvic CRT to inform future interventions, reform patient education, and improve outcomes. Methods and Materials: We surveyed 248 patients with anal cancer treated with definitive intensity modulated radiation and concurrent chemotherapy from 2010 to 2018 who were alive and without recurrence. The survey included the Functional Assessment of Cancer Therapy General 7 item version, questions about satisfaction with preparation and patient education, and an optional free-text response question. Survey free response data were analyzed using the constant comparative method of qualitative analysis. Representative themes were generated. Results: One-hundred and twelve patients (45%) completed surveys. Of these respondents, 84 (75%) answered the free-text question. The median (interquartile range) Functional Assessment of Cancer Therapy General 7 item version score for survey responders (N = 112) was 21 (range, 15-24). Three themes most mentioned by respondents were persistent toxicity effecting QOL (82%), insufficient upfront information about CRT (56%), and gratitude toward care received (35%). Conclusions: Patients described late toxicities that affect QOL after pelvic CRT for anal cancer. This may be partially due to insufficient preparative information and post-treatment support. This study contributes to the literature supporting improved patient education and side effect management to augment long-term QOL for survivors of anal cancer.
Keywords	Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Language	English
Publishing date	2022-07-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Multi-organ segmentation of abdominal structures from non-contrast and contrast enhanced CT images

Cenji Yu / Chidinma P. Anakwenze / Yao Zhao / Rachael M. Martin / Ethan B. Ludmir / Joshua S.Niedzielski / Asad Qureshi / Prajnan Das / Emma B. Holliday / Ann C. Raldow / Callistus M. Nguyen / Raymond P. Mumme / Tucker J. Netherton / Dong Joo Rhee / Skylar S. Gay / Jinzhong Yang / Laurence E. Court / Carlos E. Cardenas

Scientific Reports, Vol 12, Iss 1, Pp 1-

2022 Volume 10

Abstract: Abstract Manually delineating upper abdominal organs at risk (OARs) is a time-consuming task. To develop a deep-learning-based tool for accurate and robust auto-segmentation of these OARs, forty pancreatic cancer patients with contrast-enhanced breath- ... ...

Abstract	Abstract Manually delineating upper abdominal organs at risk (OARs) is a time-consuming task. To develop a deep-learning-based tool for accurate and robust auto-segmentation of these OARs, forty pancreatic cancer patients with contrast-enhanced breath-hold computed tomographic (CT) images were selected. We trained a three-dimensional (3D) U-Net ensemble that automatically segments all organ contours concurrently with the self-configuring nnU-Net framework. Our tool’s performance was assessed on a held-out test set of 30 patients quantitatively. Five radiation oncologists from three different institutions assessed the performance of the tool using a 5-point Likert scale on an additional 75 randomly selected test patients. The mean (± std. dev.) Dice similarity coefficient values between the automatic segmentation and the ground truth on contrast-enhanced CT images were 0.80 ± 0.08, 0.89 ± 0.05, 0.90 ± 0.06, 0.92 ± 0.03, 0.96 ± 0.01, 0.97 ± 0.01, 0.96 ± 0.01, and 0.96 ± 0.01 for the duodenum, small bowel, large bowel, stomach, liver, spleen, right kidney, and left kidney, respectively. 89.3% (contrast-enhanced) and 85.3% (non-contrast-enhanced) of duodenum contours were scored as a 3 or above, which required only minor edits. More than 90% of the other organs’ contours were scored as a 3 or above. Our tool achieved a high level of clinical acceptability with a small training dataset and provides accurate contours for treatment planning.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2022-11-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Post-Operative Prostate and Seminal Vesicle Fossae Contouring Module

Jillian Gunther / Stanley Liauw / Seungtaek Choi / Christopher Stepaniak / Prajnan Das / Daniel Golden

MedEdPORTAL, Vol

Evaluation of Medical Student Target Delineation Before and After a Teaching Intervention

2015 Volume 11

Abstract: Abstract Introduction Currently, there is a lack of formalized educational curricula for medical students rotating through radiation oncology electives. A curriculum including both didactics and hands-on training has been developed and implemented at ... ...

Abstract	Abstract Introduction Currently, there is a lack of formalized educational curricula for medical students rotating through radiation oncology electives. A curriculum including both didactics and hands-on training has been developed and implemented at numerous institutions throughout the nation. We have developed an additional module to augment this curriculum and give students experience with contouring tools used in treatment planning software. We also aim to teach a functional approach to contouring an unfamiliar target volume, a task certainly encountered during the early months of residency. Methods This module was developed using a CT image set of a prostate cancer patient who has undergone prostatectomy. The clinical target volume (CTV) for this patient was delineated and confirmed by two genitourinary radiation oncology experts. A teaching guide, in PowerPoint format, was constructed to provide educational information on prostate and pelvic anatomy, contouring resources, and a step-by-step guide to contouring this specific CTV. Results Across two institutions, 24 students completed the contouring module, and 21 completed the post-session evaluation. Out of the 21 who completed the postsession evaluation, eight students had participated in the care of a post-prostatectomy patient, and three were familiar with post-prostatectomy contouring guidelines. All students regarded this exercise as “moderately” (five students), “quite” (eight students), or “extremely” (eight students) important. The students reported their comfort/confidence level with a number of tasks. Many more students felt “moderately,” “quite,” or “extremely” comfortable (in contrast to “slight” or “not at all”) after the teaching intervention for the following questions: ability to contour a PF (four students before vs. 20 after), ability to find and use contouring resources (10 before vs. 21 after), knowledge of CT prostate/pelvis anatomy (eight before vs. 21 after), and ability to use treatment planning software (nine before vs. 21 after). ...
Keywords	Prostate ; Genitourinary ; Medical Student ; Radiation Oncology ; Contouring ; Prostate Fossa ; Medicine (General) ; R5-920 ; Education ; L
Subject code	028
Language	English
Publishing date	2015-09-01T00:00:00Z
Publisher	Association of American Medical Colleges
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: NBTXR3, a first-in-class radioenhancer for pancreatic ductal adenocarcinoma

Alexander F. Bagley / Ethan B. Ludmir / Anirban Maitra / Bruce D. Minsky / Grace Li Smith / Prajnan Das / Albert C. Koong / Emma B. Holliday / Cullen M. Taniguchi / Matthew H.G. Katz / Eric P. Tamm / Robert A. Wolff / Michael J. Overman / Shivani Patel / Michael P. Kim / Ching-Wei D. Tzeng / Naruhiko Ikoma / Manoop S. Bhutani / Eugene J. Koay

Clinical and Translational Radiation Oncology, Vol 33, Iss , Pp 66-

Report of first patient experience

2022 Volume 69

Abstract: Background and purpose: Pancreatic ductal adenocarcinoma (PDAC) remains one of the leading causes of cancer-related deaths in the world. For patients with PDAC who are not eligible for surgery, radiation therapy improves local disease control, yet safely ...

Abstract	Background and purpose: Pancreatic ductal adenocarcinoma (PDAC) remains one of the leading causes of cancer-related deaths in the world. For patients with PDAC who are not eligible for surgery, radiation therapy improves local disease control, yet safely delivering therapeutic doses of radiation remains challenging due to off-target toxicities in surrounding normal tissues. NBTXR3, a novel radioenhancer composed of functionalized hafnium oxide crystalline nanoparticles, has recently shown clinical activity in soft tissue sarcoma, hepatocellular carcinoma, head and neck squamous cell carcinoma, and advanced solid malignancies with lung or liver metastases. Here we report the first patient with pancreatic cancer treated with NBTXR3. Materials and methods: A 66-year-old male with unresectable locally advanced PDAC was enrolled on our clinical trial to receive NBTXR3 activated by radiation therapy. Local endoscopic delivery of NBTXR3 was followed by intensity modulated radiation therapy (IMRT). Follow-up assessment consisted of physical examination, laboratory studies including CA19-9, and CT of the chest, abdomen, and pelvis. Results: The patient received NBTXR3 by local endoscopic delivery without any acute adverse events. Radiation treatment consisted of 45 Gy in 15 daily fractions using IMRT. The patient began radiation twelve days after NBTXR3 injection. Daily CT-on-rails imaging demonstrated retention of NBTXR3 within the tumor for the duration of treatment. At initial follow-up evaluation, the lesion remained radiographically stable and the patient did not demonstrate treatment-related toxicity. Conclusion: This report demonstrates initial feasibility of local endoscopic delivery of NBTXR3 activated by radiation therapy for patients with pancreatic cancer who are not eligible for surgery.
Keywords	Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Subject code	616 ; 610
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Dose Escalation for Pancreas SBRT

Dong Joo Rhee, PhD / Sam Beddar, PhD / Joseph Abi Jaoude, MD / Gabriel Sawakuchi, PhD / Rachael Martin, PhD / Luis Perles, PhD / Cenji Yu, BA / Yulun He, BA / Laurence E. Court, PhD / Ethan B. Ludmir, MD / Albert C. Koong, MD, PhD / Prajnan Das, MD, MS, MPH / Eugene J. Koay, MD, PhD / Cullen Taniguichi, MD, PhD / Joshua S. Niedzielski, PhD

Advances in Radiation Oncology, Vol 8, Iss 4, Pp 101164- (2023)

Potential and Limitations of using Daily Online Adaptive Radiation Therapy and an Iterative Isotoxicity Automated Planning Approach

2023

Abstract: Purpose: To determine the dosimetric limitations of daily online adaptive pancreas stereotactic body radiation treatment by using an automated dose escalation approach. Methods and Materials: We collected 108 planning and daily computed tomography (CT) ... ...

Abstract	Purpose: To determine the dosimetric limitations of daily online adaptive pancreas stereotactic body radiation treatment by using an automated dose escalation approach. Methods and Materials: We collected 108 planning and daily computed tomography (CT) scans from 18 patients (18 patients × 6 CT scans) who received 5-fraction pancreas stereotactic body radiation treatment at MD Anderson Cancer Center. Dose metrics from the original non-dose-escalated clinical plan (non-DE), the dose-escalated plan created on the original planning CT (DE-ORI), and the dose-escalated plan created on daily adaptive radiation therapy CT (DE-ART) were analyzed. We developed a dose-escalation planning algorithm within the radiation treatment planning system to automate the dose-escalation planning process for efficiency and consistency. In this algorithm, the prescription dose of the dose-escalation plan was escalated before violating any organ-at-risk (OAR) dose constraint. Dose metrics for 3 targets (gross target volume [GTV], tumor vessel interface [TVI], and dose-escalated planning target volume [DE-PTV]) and 9 OARs (duodenum, large bowel, small bowel, stomach, spinal cord, kidneys, liver, and skin) for the 3 plans were compared. Furthermore, we evaluated the effectiveness of the online adaptive dose-escalation planning process by quantifying the effect of the interfractional dose distribution variations among the DE-ART plans. Results: The median D95% dose to the GTV/TVI/DE-PTV was 33.1/36.2/32.4 Gy, 48.5/50.9/40.4 Gy, and 53.7/58.2/44.8 Gy for non-DE, DE-ORI, and DE-ART, respectively. Most OAR dose constraints were not violated for the non-DE and DE-ART plans, while OAR constraints were violated for the majority of the DE-ORI patients due to interfractional motion and lack of adaptation. The maximum difference per fraction in D95%, due to interfractional motion, was 2.5 ± 2.7 Gy, 3.0 ± 2.9 Gy, and 2.0 ± 1.8 Gy for the TVI, GTV, and DE-PTV, respectively. Conclusions: Most patients require daily adaptation of the radiation planning ...
Keywords	Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Subject code	616 ; 610
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: HPV-related anal cancer is associated with changes in the anorectal microbiome during cancer development

Jacob H. Elnaggar / Victoria O. Huynh / Daniel Lin / R. Tyler Hillman / Chike O. Abana / Molly B. El Alam / Katarina C. Tomasic / Tatiana V. Karpinets / Ramez Kouzy / Jae L. Phan / Jennifer Wargo / Emma B. Holliday / Prajnan Das / Melissa P. Mezzari / Nadim J. Ajami / Erica J. Lynn / Bruce D. Minsky / Van K. Morris / Andrea Milbourne /

Craig A. Messick / Ann H. Klopp / P. Andrew Futreal / Cullen M. Taniguchi / Kathleen M. Schmeler / Lauren E. Colbert

Frontiers in Immunology, Vol

2023 Volume 14

Abstract: BackgroundSquamous cell carcinoma of the anus (SCCA) is a rare gastrointestinal cancer. Factors associated with progression of HPV infection to anal dysplasia and cancer are unclear and screening guidelines and approaches for anal dysplasia are less ... ...

Abstract	BackgroundSquamous cell carcinoma of the anus (SCCA) is a rare gastrointestinal cancer. Factors associated with progression of HPV infection to anal dysplasia and cancer are unclear and screening guidelines and approaches for anal dysplasia are less clear than for cervical dysplasia. One potential contributing factor is the anorectal microbiome. In this study, we aimed to identify differences in anal microbiome composition in the settings of HPV infection, anal dysplasia, and anal cancer in this rare disease.MethodsPatients were enrolled in two prospective studies. Patients with anal dysplasia were part of a cross-sectional cohort that enrolled women with high-grade lower genital tract dysplasia. Anorectal tumor swabs were prospectively collected from patients with biopsy-confirmed locally advanced SCCA prior to receiving standard-of-care chemoradiotherapy (CRT). Patients with high-grade lower genital tract dysplasia without anal dysplasia were considered high-risk (HR Normal). 16S V4 rRNA Microbiome sequencing was performed for anal swabs. Alpha and Beta Diversity and composition were compared for HR Normal, anal dysplasia, and anal cancer.Results60 patients with high-grade lower genital tract dysplasia were initially enrolled. Seven patients had concurrent anal dysplasia and 44 patients were considered HR Normal. Anorectal swabs from 21 patients with localized SCCA were included, sequenced, and analyzed in the study. Analysis of weighted and unweighted UniFrac distances demonstrated significant differences in microbial community composition between anal cancer and HR normal (p=0.018). LEfSe identified that all three groups exhibited differential enrichment of specific taxa. Peptoniphilus (p=0.028), Fusobacteria (p=0.0295), Porphyromonas (p=0.034), and Prevotella (p=0.029) were enriched in anal cancer specimens when compared to HR normal.ConclusionAlthough alpha diversity was similar between HR Normal, dysplasia and cancer patients, composition differed significantly between the three groups. Increased ...
Keywords	anal cancer ; anorectal microbiome ; HPV-related cancer ; anal dysplasia ; cancer biology ; Immunologic diseases. Allergy ; RC581-607
Subject code	610
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Assessment of setup uncertainty in hypofractionated liver radiation therapy with a breath-hold technique using automatic image registration–based image guidance

Gye Won Choi / Yelin Suh / Prajnan Das / Joseph Herman / Emma Holliday / Eugene Koay / Albert C. Koong / Sunil Krishnan / Bruce D. Minsky / Grace L. Smith / Cullen M. Taniguchi / Sam Beddar

Radiation Oncology, Vol 14, Iss 1, Pp 1-

2019 Volume 9

Abstract: Abstract Background Target localization in radiation therapy is affected by numerous sources of uncertainty. Despite measures to minimize the breathing motion, the treatment of hypofractionated liver radiation therapy is further challenged by residual ... ...

Abstract	Abstract Background Target localization in radiation therapy is affected by numerous sources of uncertainty. Despite measures to minimize the breathing motion, the treatment of hypofractionated liver radiation therapy is further challenged by residual uncertainty coming from involuntary organ motion and daily changes in the shape and location of abdominal organs. To address the residual uncertainty, clinics implement image-guided radiation therapy at varying levels of soft-tissue contrast. This study utilized the treatment records from the patients that have received hypofractionated liver radiation therapy using in-room computed tomography (CT) imaging to assess the setup uncertainty and to estimate the appropriate planning treatment volume (PTV) margins in the absence of in-room CT imaging. Methods We collected 917 pre-treatment daily in-room CT images from 69 patients who received hypofractionated radiation therapy to the liver with the inspiration breath-hold technique. For each treatment, the daily CT was initially aligned to the planning CT based on the shape of the liver automatically using a CT-CT alignment software. After the initial alignment, manual shift corrections were determined by visual inspection of the two images, and the corrections were applied to shift the patient to the physician-approved treatment position. Considering the final alignment as the gold-standard setup, systematic and random uncertainties in the automatic alignment were quantified, and the uncertainties were used to calculate the PTV margins. Results The median discrepancy between the final and automatic alignment was 1.1 mm (0–24.3 mm), and 38% of treated fractions required manual corrections of ≥3 mm. The systematic uncertainty was 1.5 mm in the anterior-posterior (AP) direction, 1.1 mm in the left-right (LR) direction, and 2.4 mm in the superior-inferior (SI) direction. The random uncertainty was 2.2 mm in the AP, 1.9 mm in the LR, and 2.2 mm in the SI direction. The PTV margins recommended to be used in the absence of ...
Keywords	Setup uncertainty ; IGRT ; In-room CT ; Liver radiotherapy ; PTV margin ; Medical physics. Medical radiology. Nuclear medicine ; R895-920 ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282
Subject code	610
Language	English
Publishing date	2019-08-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Treatment Patterns for Gastroesophageal Junction Adenocarcinoma in the United States

Bradford J. Kim / Yi-Ju Chiang / Prajnan Das / Bruce D. Minsky / Mariela A. Blum / Jaffer A. Ajani / Jeannelyn S. Estrella / Wayne L. Hofstetter / Ching-Wei D. Tzeng / Brian D. Badgwell / Paul F. Mansfield / Naruhiko Ikoma

Journal of Clinical Medicine, Vol 9, Iss 3495, p

2020 Volume 3495

Abstract: Despite the increasing incidence of gastroesophageal junction adenocarcinoma (GEJA), the optimal treatment strategy for the disease remains unknown. The objective of this study was to describe treatment patterns for GEJA in the United States. The ... ...

Abstract	Despite the increasing incidence of gastroesophageal junction adenocarcinoma (GEJA), the optimal treatment strategy for the disease remains unknown. The objective of this study was to describe treatment patterns for GEJA in the United States. The National Cancer Database was searched to identify all patients who underwent resection of the lower esophagus, abdominal esophagus, and/or gastric cardia for GEJA between 2006 and 2016. Patients were grouped by clinical disease stage: early localized (L; T1-2N0), locally advanced (LA; T3-4N0), regional (R; T1-2N+), or regionally advanced (RA; T3-4N+). The search identified 28,852 GEJA patients. The dominant age range was 60–69 years (39%). Most patients were men (85%), and most were white (92%). Most L patients (69%) underwent upfront surgery, whereas most LA, R, and RA patients received neoadjuvant therapy (NAT; 86%, 80%, and 90%, respectively). Among patients who received NAT, 85% received chemoradiotherapy. Adjuvant therapy was relatively uncommon across all groups (15–20%). In the LA, R, and RA groups, overall survival was greater in patients who received NAT compared to upfront surgery ( p < 0.001). With the exception of patients with early localized node-negative disease, most GEJA patients receive neoadjuvant chemoradiotherapy despite the lack of prospective trials reporting survival benefit over chemotherapy alone.
Keywords	chemoradiation ; esophagectomy ; gastrectomy ; GEJ ; neoadjuvant therapy ; Medicine ; R
Subject code	610 ; 616
Language	English
Publishing date	2020-10-01T00:00:00Z
Publisher	MDPI AG
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