Abstract 402P
Background
Patients (pts) with stage I SCCA are underrepresented in randomized trials of chemoradiation (CRT). While most pts are cured with CRT, this may lead to significant acute and long-term adverse events. Thus less intensive treatments (LIT) for these pts could be as effective and less toxic than CRT. We compared the outcomes of real-world stage I SCCA pts treated with CRT versus LIT.
Methods
Retrospective study using the population database of FOSP (Fundação Onco-Centro de São Paulo), which collects epidemiological and outcomes data on cancers from 77 hospitals across the state of Sao Paulo, Brazil. Pts with stage I SCCA were eligible. The primary endpoint was to compare disease-free survival (DFS) times between pts treated with CRT (radiation plus chemotherapy with or without adjunctive surgery) and LIT (only surgery, radiation or chemotherapy, or surgery and radiation). DFS were compared with the log-rank test and adjusted by a Cox regression model. Logistic regression was used to evaluate factors associated with LIT.
Results
From 2000 to 2020, 171 out of 2,401 SCCA pts had stage I tumors and were included. The median time from diagnosis to treatment was 67 days, 131 (76%) was female, median age was 59 years (35 - 90); 100 pts (58%) received CRT and 71 (42%) LIT, with 98 (57%) being treated in the public system. In a median follow up of 43.3 months, 21 (12.2%) pts recurred (12 in CRT and 9 in LIT). Median DFS was 39.2 and 24 months for CRT and LIT (p=0.57), respectively. Either treatment type (CRT vs LIT), sex, age or time from diagnosis to treatment initiation 60 days were associated with DFS. After controlling for sex, health care setting (insurance/private vs public) and treatment location (within or outside of residential city), age 70 years was associated with receipt of LIT (OR: 2.34; 95% CI: 1.15 – 4.87; p = 0.019). There was also no difference in DFS (p=0.2) in the subgroup treated with CRT (79) or radiation only (17).
Conclusions
In this large study of real-world stage I SCCA pts, LIT was more likely to be offered to older pts and was not associated with inferior DFS when compared to CRT. An organ-preserving LIT, such as radiotherapy with or without a fluoropyrimidine, can be considered to older pts with stage I SCCA who are ineligible for CRT.
Clinical trial identification
Editorial acknowledgement
NA
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.