Purpose There is little evidence comparing complications after intensity-modulated (IMRT) vs. three-dimensional conformal radiotherapy (CRT) for prostate cancer. The study objective was to test the hypothesis that IMRT, compared with CRT, is associated with a reduction in bowel, urinary, and erectile complications in elderly men with nonmetastatic prostate cancer. Methods and Materials We undertook an observational cohort study using registry and administrative claims data from the SEER-Medicare database. We identified men aged 65 years or older diagnosed with nonmetastatic prostate cancer in the United States between 2002 and 2004 who received IMRT (n = 5,845) or CRT (n = 6,753). The primary outcome was a composite measure of bowel complications. Secondary outcomes were composite measures of urinary and erectile complications. We also examined specific subsets of bowel (proctitis/hemorrhage) and urinary (cystitis/hematuria) events within the composite complication measures. Results IMRT was associated with reductions in composite bowel complications (24-month cumulative incidence 18.8% vs. 22.5%; hazard ratio [HR] 0.86; 95% confidence interval [CI], 0.79–0.93) and proctitis/hemorrhage (HR 0.78; 95% CI, 0.64–0.95). IMRT was not associated with rates of composite urinary complications (HR 0.93; 95% CI, 0.83–1.04) or cystitis/hematuria (HR 0.94; 95% CI, 0.83–1.07). The incidence of erectile complications involving invasive procedures was low and did not differ significantly between groups, although IMRT was associated with an increase in new diagnoses of impotence (HR 1.27, 95% CI, 1.14–1.42). Conclusion IMRT is associated with a small reduction in composite bowel complications and proctitis/hemorrhage compared with CRT in elderly men with nonmetastatic prostate cancer.

BACKGROUND:The optimal treatment for resected pancreatic cancer is controversial because direct comparisons of adjuvant chemotherapy (CT) alone and chemotherapy and radiotherapy (CRT) are limited. This study assessed outcomes of CT versus CRT in a national cohort to provide a modern estimate of comparative effectiveness. METHODS: Patients with pT1-3N0-1M0 pancreatic adenocarcinoma after pancreatectomy were identified in the National Cancer Data Base. Overall survival (OS) was compared for CT and CRT groups with Cox regression and propensity score matching. Subset analyses by clinicopathologic characteristics were performed. RESULTS: This study identified 6165 patients treated with CT (n 5 2334 or 38%) or CRT (n 5 3831 or 62%). Most were classified as pT3 (72%), pN1 (67%), and status-post R0 resection (84%). For CRT patients, the median radiotherapy dose was 50.4 Gy. Compared with CT, CRT was associated with improved OS in a univariate analysis (median, 20.0 vs 22.3 months; at 5 years, 16.5% vs 19.6%; P <.001) and a multivariate analysis (hazard ratio [HR], 0.893; 95% confidence interval [CI], 0.837-0.953; P 5.001). CRT remained associated with improved OS after propensity score matching (HR, 0.851; 95% CI, 0.793-0.913; P <.001). Subset analyses showed that CRT was associated with improved OS among patients with pT3 (HR, 0.892; 95% CI, 0.828-0.962; P 5.003) or pN1 disease (HR, 0.856; 95% CI, 0.793-0.924; P <.001) and both R0 resection (HR, 0.901; 95% CI, 0.839-0.969; P 5.005) and R1 resection (HR, 0.842; 95% CI, 0.722-0.983; P 5.030). CONCLUSIONS: CRT was independently associated with improved OS after the resection of pancreatic adenocarcinoma in a large national cohort and particularly among patients with R1 resection and pN1 disease. Well-designed randomized comparisons of CRT and CT are urgently needed. Cancer 2015;121:4141-9.

Medulloblastoma (MB) is the most common brain tumor in children. However, it is relatively rare in adults, with an estimated incidence of 0.6 per million. 1 The standardof-care management for pediatric MB is postoperative radiotherapy (RT) with craniospinal irradiation (CSI) and posterior fossa or resection bed boost followed by adjuvant chemotherapy. 2,3 Adoption of adjuvant chemotherapy in the pediatric setting has been associated with improved disease control and has allowed successful CSI dose deescalation in average-risk patients. [2][3][4][5] Even though chemotherapy is used routinely for pediatric patients, its benefit in adult MB is unclear. Data supporting adjuvant chemotherapy in the adult MB population are scarce. There are no randomized trials investigating the benefit of chemotherapy in adult MB, and evidence is generally limited to small retrospective series reported over several decades with conflicting results. [6][7][8][9] Furthermore, compared with children, adults may suffer less toxicity from CSI and greater morbidity from chemotherapy. This may lead to hesitancy in using postoperative chemotherapy, Adjuvant chemotherapy and overall survival in adult medulloblastoma AbstractBackground. Although chemotherapy is used routinely in pediatric medulloblastoma (MB) patients, its benefit for adult MB is unclear. We evaluated the survival impact of adjuvant chemotherapy in adult MB. Methods. Using the National Cancer Data Base, we identified patients aged 18 years and older who were diagnosed with MB in 2004-2012 and underwent surgical resection and adjuvant craniospinal irradiation (CSI). Patients were divided into those who received adjuvant CSI and chemotherapy (CRT) or CSI alone (RT). Predictors of CRT compared with RT were evaluated with univariable and multivariable logistic regression. Survival analysis was limited to patients receiving CSI doses between 23 and 36 Gy. Overall survival (OS) was evaluated using the Kaplan-Meier estimator, log-rank test, multivariable Cox proportional hazards modeling, and propensity score matching. Results. Of the 751 patients included, 520 (69.2%) received CRT, and 231 (30.8%) received RT. With median followup of 5.0 years, estimated 5-year OS was superior in patients receiving CRT versus RT (86.1% vs 71.6%, P < .0001). On multivariable analysis, after controlling for risk factors, CRT was associated with superior OS compared with RT (HR: 0.53; 95%CI: 0.32-0.88, P = .01). On planned subgroup analyses, the 5 year OS of patients receiving CRT versus RT was improved for M0 patients (P < .0001), for patients receiving 36 Gy CSI (P = .0007), and for M0 patients receiving 36 Gy CSI (P = .0008). Conclusions. This national database analysis demonstrates that combined postoperative chemotherapy and radiotherapy are associated with superior survival for adult MB compared with radiotherapy alone, even for M0 patients who receive high-dose CSI.

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