Comparison of chemoradiotherapy with radiotherapy alone for “biopsy only” anaplastic astrocytoma

// Jing Wu 1,3,* , Ting Zou 1,* , Harrison Xiao Bai 2 , Xuejun Li 5 , Zishu Zhang 6 , Bo Xiao 3 , MacLean Nasrallah 4 , Giorgos Karakousis 7 , Ya Cao 8 , Paul J. Zhang 4 and Li Yang 1 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 Correspondence to: 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 Abstract 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.