Clinical Research Papers:
Comparison of chemoradiotherapy with radiotherapy alone for “biopsy only” anaplastic astrocytoma
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Jing Wu1,3,*, Ting Zou1,*, Harrison Xiao Bai2, Xuejun Li5, Zishu Zhang6, Bo Xiao3, MacLean Nasrallah4, Giorgos Karakousis7, Ya Cao8, Paul J. Zhang4 and Li Yang1
1 Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
2 Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
3 Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
4 Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
5 Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
6 Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
7 Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
8 Cancer Research Institute, School of Basic Medicine, Central South University, Changsha, Hunan, China
* These authors have contributed equally to this study
Li Yang, email:
Keywords: chemoradiotherapy, anaplastic astrocytoma, National Cancer Database, radiotherapy, survival
Abbreviations: RT, Radiotherapy; CRT, Chemoradiotherapy; OS, Overall Survival; AA, Anaplastic Astrocytoma.
Received: December 16, 2016 Accepted: March 17, 2017 Published: April 26, 2017
Background: It has become increasingly common to incorporate adjuvant chemotherapy with radiotherapy in the treatment of resected anaplastic astrocytoma based on results from recent phase II/III randomized trials. However, whether or not combined chemoradiotherapy is associated with improved survival outcome in patients who undergo “biopsy only” is less clear.
Methods: The US National Cancer Database was used to identify patients with histologically confirmed, biopsy-only anaplastic astrocytoma who received either radiotherapy alone or combined chemoradiotherapy from 2006 through 2014.
Results: In total, 1896 patients with biopsy-only anaplastic astrocytoma were included, among whom 363 (19.1%) received radiotherapy alone and 1533 (80.9%) received combined chemoradiotherapy. The median age at diagnosis was 60 years. Combined chemoradiotherapy was associated with a significant survival benefit when compared with radiotherapy alone on univariable analysis (median, 13.2 versus 5.6 months; hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.50-0.65; p < 0.001) and on multivariable analysis (HR, 0.62; 95% CI, 0.55-0.71; p < 0.001). A significant survival benefit for combined chemoradiotherapy persisted in a propensity score-matched analysis (HR, 0.67; 95% CI, 0.56-0.78; p<0.001).
Conclusions: Our results suggest that combined chemoradiotherapy may be associated with significantly improved survival over radiotherapy alone in patients with anaplastic astrocytoma who undergo biopsy only.
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