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. 2008 Apr;22(4):393-8.
doi: 10.1155/2008/231878.

Long-term survivorship of esophageal cancer patients treated with radical intent

Alex Agranovich  1 , Colleen E McGahan, Anagha Gurjal
Affiliations

Long-term survivorship of esophageal cancer patients treated with radical intent

Alex Agranovich et al. Can J Gastroenterol. 2008 Apr.

Abstract
in English, French

To investigate the recent trends in definitive management of esophageal cancer, the records of 138 consecutive patients treated with radical intent in a single institution between 1995 and 2003 were reviewed and analyzed. The median follow-up period was 5.7 years (range 1.1 to 10.4 years). Seventy-seven patients were treated with radiation therapy (RT) only and 61 with combined regimens (CRT), in which RT was combined with either radical surgery or chemotherapy, or both. The overall survival of the entire cohort was 32% over two years and 20% over five years. The survivorship in the RT group was 17% over two years and 5% over five years. In the CRT group, 51% and 35% survived over two and five years, respectively. From all the potential prognostic factors examined by univariate and multivariate analyses, only male sex and use of CRT were strongly associated with better survivorship. There was no significant difference in the outcomes among the different regimens of CRT. Survivorship was not affected by the location or histology of the tumour, clinical stage, dose of RT or use of endoluminal brachytherapy in addition to external beam RT. There was a greater tendency to use RT only more often in older patients, but patient age did not affect survivorship. The proportion of patients treated with CRT did not change significantly over the last versus the first four years of the observed period. Combined regimens are undoubtedly superior to RT as a single modality. The long-term survivorship of patients in a subgroup of our patients treated with combined modality protocols compared favourably with the previously reported results in the literature and specifically in prospective randomized trials. However, the optimal combined modality regimen is yet to be defined.

Pour analyser les tendances récentes en matière de traitement radical pour le cancer de l’œsophage, les auteurs ont passé en revue et analysé les dossiers de 138 patients consécutifs traités de manière radicale dans un établissement, entre 1995 et 2003. La période de suivi médiane était de 5,7 ans (de 1,1 à 10,4 ans). Soixante-dix-sept patients ont été traités par radiothérapie (RT) seulement et 61 au moyen de schémas mixtes (CRT) au cours desquels la RT était combinée soit à une chirurgie radicale, soit à une chimiothérapie, soit aux deux. La survie globale de la cohorte entière a été de 32 % à deux ans et de 20 % à cinq ans. La survie du groupe sous RT a été de 17 % à deux ans et de 5 % à cinq ans, tandis que dans le groupe soumis à la CRT, 51 % et 35 % ont survécu deux et cinq ans, respectivement. De tous les facteurs pronostiques potentiels analysés par méthode uni- ou multivariée, seuls le sexe masculin et l’utilisation de la CRT ont été fortement associés à une meilleure survie. On n’a noté aucune différence significative quant à l’issue selon les différents schémas de CRT. La survie n’a pas subi d’influence de la localisation ou de l’histologie de la tumeur, du stade clinique, de la dose de RT ni de l’utilisation de brachythérapie endoluminale en plus du faisceau de RT externe. On a noté une tendance plus forte à l’utilisation de la RT seulement chez les sujets plus âgés, mais l’âge des patients n’a pas affecté la survie. La proportion de patients traités par CRT n’a pas changé significativement entre la première et la quatrième années de la période d’observation. Les schémas d’association ont été sans contredit supérieurs à la RT utilisée seule. La survie à long terme des patients dans un sous-groupe traités au moyen de protocoles thérapeutiques d’association s'est comparée favorablement aux résultats antérieurs rapportés dans la littérature et spécifiquement à ceux d’essais randomisés prospectifs. Par contre, le schéma d’association optimum reste à définir.

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Figures

Figure 1)
Figure 1)
Overall survival of the esophageal cancer patient cohort at the Fraser Valley Centre (Surrey, British Columbia), April 1, 1995 to December 31, 2003
Figure 2)
Figure 2)
Overall survival of patients at the Fraser Valley Centre (Surrey, British Columbia) between April 1, 1995 and December 31, 2003, stratified by sex
Figure 3)
Figure 3)
Overall survival of patients at the Fraser Valley Centre (Surrey, British Columbia) between April 1, 1995 and December 31, stratified by treatment subgroup. ChT Chemotherapy; RS Radical surgery; RT Radiation therapy
See this image and copyright information in PMC

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