Survival after Definitive (Chemo)Radiotherapy in Esophageal Cancer Patients: A Population-Based Study in the North-East Netherlands

• Published in: Annals of surgical oncology Vol. 20; no. 6; pp. 1985 - 1992
• Main Authors: Smit, Justin K., Muijs, Christina T., Burgerhof, Johannes G. M., Paardekooper, Gabriel, Timmer, Paul R., Muller, Karin, Woutersen, Dankert, Mul, Véronique E., Beukema, Jannet C., Hospers, Geke A. P., van Dijk, Boukje A. C., Langendijk, Johannes A., Plukker, John Th. M.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.06.2013; Springer Nature B.V
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Adenocarcinoma - therapy; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carboplatin - administration & dosage; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy; Cisplatin - administration & dosage; Confidence Intervals; Disease-Free Survival; Esophageal Neoplasms - pathology; Esophageal Neoplasms - radiotherapy; Esophageal Neoplasms - therapy; Female; Fluorouracil - administration & dosage; Gastrointestinal Oncology; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - pathology; Netherlands; Oncology; Paclitaxel - administration & dosage; Proportional Hazards Models; Radiotherapy Dosage; Surgery; Surgical Oncology; Survival Rate; Tumor Burden; Netherlands; Squamous Cell Carcinoma; Radiation Therapy Oncology Group; Gross Tumor Volume; Overall Survival; Squamous Cell Carcinoma Patient
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-012-2824-2

Background Definitive (chemo)radiotherapy is employed in esophageal cancer patients as an alternative for patients considered medically unfit for surgery or having unresectable tumors. We evaluated a population-based cohort to improve the selection for intensified nonsurgical strategies and to identify prognostic factors. Methods Patients who had squamous cell carcinoma (SCC) or adenocarcinoma (AC) were treated in four referral centers in the north-east Netherlands with definitive chemoradiotherapy (dCRT) or radiotherapy (dRT) between 1996 and 2008. Results Of the 287 included patients, 110 were treated with dCRT and 177 with dRT. Median overall survival (OS) was 11 months (95 % confidence interval: 10–12 months), with OS of 22 and 8 % and disease-free survival (DFS) of 16 and 5 % at 2 and 5 years, respectively. DFS at 2 and 5 years was 24 and 9 % for SCC versus 10 and 2 % for AC patients ( P  = 0.006). OS after 2 and 5 years was 29 and 14 % for SCC patients versus 17 and 3 % for AC patients ( P  = 0.044). On multivariate Cox regression, SCC was an independent prognostic factor for DFS [ P  = 0.020, hazard ratio (HR) = 0.71] and OS ( P  = 0.047, HR = 0.76). On matched cohort analysis, DFS was higher in the dCRT group compared with dRT patients ( P  = 0.016). The locoregional failure rate was lower in the dCRT group and in SCC patients ( P  = 0.001 and 0.046). Conclusions Long-term results and the local control rate in SCC patients were better after definitive (chemo)radiotherapy compared with in AC patients. SCC was an independent prognostic factor for survival. Definitive chemoradiotherapy leads to improved local control rate and DFS.