A Matched Case-Control Analysis of Clinical Outcomes for Inflammatory Bowel Disease Patients with Rectal Cancer Treated with Pelvic Radiation Therapy

Abstract

patients had tumoral PD-L1 expression !5%. Patients with tumoral PD-L1 !5% had better OS vs those with lower expression, HRZ0.29 (CI 0.10-0.78), pZ0.009; 10 years OS: 84% for PD-L1 !5% vs. 46% for PD-L1 <5%. On univariate analysis, OS was associated with PD-L1 status, as well as T stage, N stage, ECOG status and gender. On multivariate analysis, PD-L1 !5% remained statistically significant for better OS, HRZ0.35 (CI 0.12-0.99), pZ0.047. 33 of 65 (51%) of tumors had high CD8 levels (3 or 4). There was no association between CD8 status and OS; further stratifying PD-L1 high patients by CD8 did not improve the prognostic impact vs PD-L1 status alone. Conclusion: This is the first study reporting significant association of PD-L1 expression with OS in patients with anal cancer treated with CRT. PD-L1 status warrants consideration in the prognostication of patients with anal cancer. Future studies are required to determine the benefit of alternative treatment strategies based on PD-L1 status.

Should inflammatory bowel disease be a contraindication to radiation therapy: a systematic review of acute and late toxicities

“…11 There was a SS higher rate of SBO (OR 15, 95% CI 1•9-115, p = 0•009) and higher rates of abdominopelvic adhesions that approached statistical significance (OR 3•6, 95% CI 0•98-13, p = 0•05) in the IBD þ RT cohort. 11 When compared to the nonmatched cohort with IBD treated without RT, there was no difference in long-term complications, suggesting that these adhesions or obstructions may be unrelated to RT. 11 Chang et al reported on 15 anal/rectal cancer patients with IBD treated with EBRT.…”

“…Reported late toxicities in prostate cancer studies are also reported in Table 3B, with a range for late toxicity ≥ grade 2 of 6•3-17% for EBRT (2 studies reporting) and 0-38% for brachytherapy (4 studies reporting), and late toxicity ≥ grade 3 of 0% (1 study reporting) for EBRT and 0-15% for brachytherapy (3 studies reporting). When looking at those studies that only included gastrointestinal (GI) primary malignancies [9][10][11][12] , namely rectal and anal cancers, the reported range for acute toxicity ≥ grade 3 was 0-28% and the late toxicity ≥ grade 3 was 13% (Table 3B).…”

“…Several studies also compared toxicities with matched controls at their individual institutions 2,3,[10][11][12]14 and are highlighted in Table 4. In an abstract published in IJROBP, Rhome et al reported on 64 patients with IBD and a primary malignancy (mostly comprised of GI and prostate malignancies), with 42 of 64 patients treated with RT for their cancer and 22 of 64 treated without radiation.…”

“…3 Mudgway et al reported on 71 patients with IBD and rectal cancer treated with EBRT compared with 71 matched controls with rectal cancer without IBD treated with EBRT, and 44 nonmatched controls with IBD and rectal cancer treated without EBRT. 11 In the acute setting, there were no differences in breaks in RT, anti-diarrheal medication use or hospitalisations when compared to matched controls [although hospitalisations approached significance (adjusted OR 2•69, 95% CI, 0•88-8•22, p = 0•08)]. 11 There was a SS higher rate of SBO (OR 15, 95% CI 1•9-115, p = 0•009) and higher rates of abdominopelvic adhesions that approached statistical significance (OR 3•6, 95% CI 0•98-13, p = 0•05) in the IBD þ RT cohort.…”

“…11 In the acute setting, there were no differences in breaks in RT, anti-diarrheal medication use or hospitalisations when compared to matched controls [although hospitalisations approached significance (adjusted OR 2•69, 95% CI, 0•88-8•22, p = 0•08)]. 11 There was a SS higher rate of SBO (OR 15, 95% CI 1•9-115, p = 0•009) and higher rates of abdominopelvic adhesions that approached statistical significance (OR 3•6, 95% CI 0•98-13, p = 0•05) in the IBD þ RT cohort. 11 When compared to the nonmatched cohort with IBD treated without RT, there was no difference in long-term complications, suggesting that these adhesions or obstructions may be unrelated to RT.…”