Patterns of Failure After Trimodal Treatment in Esophageal Squamous Cell Carcinoma: Initial Experiences from a High-Risk
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ORIGINAL ARTICLE
Patterns of Failure After Trimodal Treatment in Esophageal Squamous Cell Carcinoma: Initial Experiences from a High-Risk Endemic Area Sheikh Zahoor Ahmad 1 & Azhar Jan Battoo 1 & Altaf Gauhar Haji 1 & Shah Naveed 1 & Mariya Amin Qurieshi 2 & Abdul Wahid Mir 1 & Tariq Rasool Malik 3 Received: 26 February 2020 / Accepted: 7 July 2020 # Indian Association of Surgical Oncology 2020
Abstract Recurrence is a significant problem faced in patients with esophageal cancer even after treatment with trimodal approach. We report patterns of failure in our patients of esophageal squamous cell cancer (ESCC) treated with trimodal approach. This is a single-institution retrospective analysis of 46 patients of locally advanced ESCC (treated between 2013 and 2017) managed by trimodal treatment approach. Variables were summarized using descriptive statistics. Survival statistics were estimated using Kaplan-Meier method. With a median follow-up of about 28 months, we noted an overall recurrence rate of 37% (17/46), with most of the failures being distant, with or without locoregional recurrence (4 isolated distant and 6 combined distant and locoregional). Median RFS was 34 months and median OS was yet to be reached at the last follow-up. To conclude, optimization of treatment approaches in ESCC is of utmost importance and need of the hour to further improve outcomes in these patients. Keywords Esophagus . Cancer . Squamous cell carcinoma . Trimodal therapy . Neoadjuvant chemoradiation
Introduction Esophageal cancer accounted for 3.2% of all new cancers diagnosed in 2018 worldwide, ranking7th in incidence and being responsible for 1 in every 20 cancer-related deaths [1]. Esophageal cancer has a striking geographical variation in incidence, most probably reflecting the differences in prevalence of its risk factors and differential susceptibility of the underlying population [2]. Kashmir, which is located in the northernmost part of India, lying at an altitude of around 4000 m above sea level, lies near the southern rim of the socalled Asian Esophageal Cancer Belt, extending from northern Sin-Kiang (China) in the east to Caspian littoral area of
* Sheikh Zahoor Ahmad [email protected] 1
Department of Surgical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, J&K 190011, India
2
Department of Community Medicine, Government Medical College, Srinagar 190002, India
3
Department of Radiation Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar 190011, India
Iran in the west [2, 3]. In the absence of a population-based cancer registry, the data published from the only hospitalbased cancer registry of Kashmir region depicts esophageal cancer to be the leading cancer affecting people from this area [4]. Esophageal cancer comprises two major histological subtypes—squamous cell carcinoma (SCC) and adenocarcinoma (AC), which are considered to be two different entities, etiologically, epidemiologically, clinically, and biologically [5], despite the fact that they have been treated as a ho
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