Outcome of proximal esophageal cancer after definitive combined chemo-radiation: a Swiss multicenter retrospective study
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RESEARCH
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Outcome of proximal esophageal cancer after definitive combined chemo-radiation: a Swiss multicenter retrospective study Evelyn Herrmann1*, Nando Mertineit1,5, Berardino De Bari2,6, Laura Hoeng3, Francesca Caparotti4, Dominic Leiser1, Raphael Jumeau2, Nikola Cihoric1, Alexandra D. Jensen1, Daniel M. Aebersold1 and Mahmut Ozsahin2
Abstract Objective: To report oncological outcomes and toxicity rates, of definitive platin-based chemoradiadiationtherapy (CRT) in the management of proximal esophageal cancer. Methods: We retrospectively reviewed the medical records of patients with cT1-4 cN0-3 cM0 cervical esophageal cancer (CEC) (defined as tumors located below the inferior border of the cricoid cartilage, down to 22 cm from the incisors) treated between 2004 and 2013 with platin–based definitive CRT in four Swiss institutions. Acute and chronic toxicities were retrospectively scored using the National Cancer Institute’s Common Terminology Criteria for Adverse Events, version 4.0 (CTCAE-NCI v.4.0). Primary endpoint was loco-regional control (LRC). We also evaluated overall survival (OS) and disease-free survival (DFS) rates. The influence of patient- and treatment related features have been calculated using the Log-rank test and multivariate Cox proportional hazards model. Results: We enrolled a total of 55 patients. Median time interval from diagnosis to CRT was 78 days (6–178 days). Median radiation dose was 56Gy (28–72Gy). Induction chemotherapy (ICHT) was delivered in 58% of patients. With a median follow up of 34 months (6–110months), actuarial 3-year LRC, DFS and OS were 52% (95% CI: 37–67%), 35% (95% CI: 22–50%) and 52% (95% CI: 37–67%), respectively. Acute toxicities (dysphagia, pain, skin-toxicity) ranged from grade 0 – 4 without significant dose-dependent differences. On univariable analyses, the only significant prognostic factor for LRC was the time interval > 78 days from diagnosis to CRT. On multivariable analysis, total radiation dose >56Gy (p 0.10), since the number of patients in each group (ICHT vs. non-ICHT group) was small. On UVA (Table 2) longer time interval (>78 vs. 56Gy and ICHT were independent
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positive predictive factors for DFS [(p < 0.03) and (p < 0.02), respectively], and OS [(p < 0.006) and (p < 0.004), respectively]. T and N categories were not statistically significant predictive prognostic factors for LRC, DFS or OS (p >0.05).
Discussion In the present study, we report results from a multicenter cohort of CEC patients treated with definitive CRT, with or without ICHT. No prospective clinical trials exist in CEC to guide treatment. Few retrospective studies were published, illustrating the outcomes of definitive CRT in CEC. These series were heterogeneous in terms of RT techniques, CHT regimens, and radiation doses. Approximately 59% of patients within these reports [6, 13, 15, 19, 26–28] received RT alone, and 41% received CRT [7, 13, 14, 16, 19, 26–29]. When a concurrent treatment approach was chosen, 22% of these patients received ICHT [16, 20,
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