Health Services Research

SS 44 - HSR 2 - Health Services Research

324 - Quality-Adjusted Survival in Women With Gynecologic Malignancies Receiving IMRT After Surgery: A Patient Reported Outcome Study of RTOG 1203

Wednesday, October 24
3:35 PM - 3:45 PM
Location: Room 008

Quality-Adjusted Survival in Women With Gynecologic Malignancies Receiving IMRT After Surgery: A Patient Reported Outcome Study of RTOG 1203
A. A. Konski1, S. Deshmukh2, A. H. Klopp3, A. R. Yeung4, S. N. Westin5, J. S. Thomson6, D. E. Doncals7, G. H. C. Cantuaria8, D. P. D'Souza9, A. Chang10, V. Kundapur11, D. S. Mohan12, M. Haas13, Y. B. B. Kim14, C. L. Ferguson15, S. Pugh16, and L. A. Kachnic17; 1University of Pennsylvania, Philadelphia, PA, 2American College of Radiology, Philadelphia, PA, 3Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 4Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, 5Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 6University of Oklahoma Health Sciences Center, Oklahoma City, OK, 7SUMMA Akron City Hospital, Akron, OH, 8Northside Hospital Cancer Institute, Atlanta, GA, 9London Health Sciences Centre, London, ON, Canada, 10Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong, 11Saskatoon Cancer Centre, Saskatoon, SK, Canada, 12Kaiser Permanente Cancer Treatment Center, San Francisco, CA, 13Tower Health, Reading, PA, 14MD Anderson Cancer Center, Houston, TX, 15Augusta University, Augusta, GA, 16NRG Oncology Statistics and Data Management Center, Philadelphia, PA, 17Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN

Purpose/Objective(s): RTOG 1203 compared 3-D conformal radiation therapy (3D CRT) to intensity-modulated radiation therapy (IMRT) in patients (pts) with endometrial or cervical cancer requiring post-operative radiation therapy (RT) after hysterectomy. The purpose of this study was to report the first quality-adjusted survival analysis comparing the two treatments.

Materials/Methods: RTOG 1203 randomized pts having undergone hysterectomy to either 3DCRT or IMRT. Stratification factors included RT dose, chemotherapy, and disease site. The EQ-5D, both index and visual analog scale (VAS) were obtained at baseline, 5 weeks after the start of RT, 4-6 weeks post RT and 1& 3-years post RT. Quality adjusted survival (QAS) was calculated as the summation of index score multiplied by the duration of days and restricted to patients completing the EQ-5D at baseline and at least one follow-up assessment. EQ-5D index and VAS scores along with QAS were compared between treatment arms using the t-test at a two-sided significance level of 0.05.

Results: RTOG 1203 enrolled 289 pts of which 236 consented to participating in the patient reported outcome (PRO) tools. Compliance for the index score and VAS was 93.6% vs 83.5%, 80.5% vs 72.0%, 81.4% vs 72.5% and 68.6% vs 63.6% at baseline, week 5 of RT, 4-6 weeks post RT and 1-year post RT, respectively. QAS was not statistically different in women treated with IMRT, 792.7 days vs 785.6 days (p=0.86) compared to pts treated with 3DCRT. Pts treated with IMRT had less of a decline in VAS score 5 weeks post RT, -4.90, compared to pts treated with 3DCRT, -7.48, although not statistically significant (p=0.36).

Conclusion: There was no difference in QAS and VAS score between patients who received IMRT vs. 3DCRT. These were secondary endpoints and the trial was not powered to show statistical differences in these endpoints. This is the first RTOG/NRG study to report QAS as an endpoint. This work may help inform statistical power for future studies of IMRT in the treatment of pts after surgery for gynecologic malignancy.

Author Disclosure: A.A. Konski: Stock; General Electric Stock. President-elect; American Radium Society. Board of Chancellors; American College of Radiology. S. Deshmukh: None. A.H. Klopp: Research Grant; MD Anderson Cancer Center SPORE Grant. A.R. Yeung: None. D.E. Doncals: None. G.H. Cantuaria: None. A. Chang: None. M. Haas: None. C.L. Ferguson: None. L.A. Kachnic: Research Grant; NCI NCORP, SWOG. Honoraria; Up-to-Date. Trustee; ABR.

Andre Konski, MD, MBA, FASTRO

University of Pennsylvania

Disclosure:
Employment
University of Pennsylvania: Professor of Clinical Radiation Oncology: Employee

Ownership
General Electric Stock: Stock

Leadership
American College of Radiology: Board of Chancellors; American Radium Society: President-elect

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