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Comparative Study
. 2015 Jul;56(4):742-9.
doi: 10.1093/jrr/rrv022. Epub 2015 Apr 23.

Prognostic factors, patterns of recurrence and toxicity for patients with esophageal cancer undergoing definitive radiotherapy or chemo-radiotherapy

Matthias F Haefner  1 , Kristin Lang  2 , David Krug  2 , Stefan A Koerber  2 , Lorenz Uhlmann  3 , Meinhard Kieser  3 , Juergen Debus  4 , Florian Sterzing  4
Affiliations
Comparative Study

Prognostic factors, patterns of recurrence and toxicity for patients with esophageal cancer undergoing definitive radiotherapy or chemo-radiotherapy

Matthias F Haefner et al. J Radiat Res. 2015 Jul.

Abstract

The aim of this study was to evaluate the effectiveness and tolerability of definitive chemo-radiation or radiotherapy alone in patients with esophageal cancer. We retrospectively analyzed the medical records of n = 238 patients with squamous cell carcinoma or adenocarcinoma of the esophagus treated with definitive radiotherapy with or without concomitant chemotherapy at our institution between 2000 and 2012. Patients of all stages were included to represent actual clinical routine. We performed univariate and multivariate analysis to identify prognostic factors for overall survival (OS) and progression-free survival (PFS). Moreover, treatment-related toxicity and patterns of recurrence were assessed. Patients recieved either chemo-radiation (64%), radiotherapy plus cetuximab (10%) or radiotherapy alone (26%). In 69%, a boost was applied, resulting in a median cumulative dose of 55.8 Gy; the remaining 31% received a median total dose of 50 Gy. For the entire cohort, the median OS and PFS were 15.0 and 11.0 months, respectively. In multivariate analysis, important prognostic factors for OS and PFS were T stage (OS: P = 0.005; PFS: P = 0.006), M stage (OS: P = 0.015; PFS: P = 0.003), concomitant chemotherapy (P < 0.001) and radiation doses of >55 Gy (OS: P = 0.019; PFS: P = 0.022). Recurrences occurred predominantly as local in-field relapse or distant metastases. Toxicity was dominated by nutritional impairment (12.6% with G3/4 dysphagia) and chemo-associated side effects. Definitive chemo-radiation in patients with esophageal cancer results in survival rates comparable with surgical treatment approaches. However, local and distant recurrence considerably restrict prognosis. Further advances in radio-oncological treatment strategies are necessary for improving outcome.

Keywords: definitive chemo-radiation; esophageal cancer; prognostic factors; radiotherapy; toxicity.

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Figures

Fig. 1.
Fig. 1.
Kaplan–Meier estimates of overall survival (OS) and progression-free survival (PFS) for the entire cohort.
Fig. 2.
Fig. 2.
Kaplan–Meier estimates of overall survival (OS) for patients receiving a total dose of ≤55 Gy vs >55 Gy.
Fig. 3.
Fig. 3.
Kaplan–Meier estimates of overall survival (OS) for patients with or without addition of chemotherapy to irradiation.
See this image and copyright information in PMC

References

    1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011;61:69–90. - PubMed
    1. Hur C, Miller M, Kong CY, et al. Trends in esophageal adenocarcinoma incidence and mortality. Cancer 2013;119:1149–58. - PMC - PubMed
    1. Lofdahl HE, Lane A, Lu Y, et al. Increased population prevalence of reflux and obesity in the United Kingdom compared with Sweden: a potential explanation for the difference in incidence of esophageal adenocarcinoma. Eur J Gastroenterol Hepatol 2011;23:128–32. - PubMed
    1. Sjoquist KM, Burmeister BH, Smithers BM, et al. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 2011;12:681–92. - PubMed
    1. Ariga H, Nemoto K, Miyazaki S, et al. Prospective comparison of surgery alone and chemoradiotherapy with selective surgery in resectable squamous cell carcinoma of the esophagus. Int J Radiat Oncol Biol Phys 2009;75:348–56. - PubMed

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