The Changing Use of Palliative Chemotherapy for Recurrent Esophagogastric Cancer: A Single Center Retrospective 15-Year
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The Changing Use of Palliative Chemotherapy for Recurrent Esophagogastric Cancer: A Single Center Retrospective 15-Year Review S. J. Amonkar & M. Irving & J. Wayman & T. Sriram & S. M. Griffin & J. J. Nicoll & S. A. Raimes
Published online: 24 February 2009 # Humana Press Inc. 2009
Abstract Background Palliative chemotherapy is often recommended in the treatment of recurrent esophagogastric (EG) cancer with limited evidence of its benefit. This study aims to define the current practice and benefit of this treatment. Methods Retrospective analysis of patients who developed EG cancer recurrence between 1991 and 2006 following surgery with curative intent. Results There were 336 recurrences. Median time to disease recurrence was 13.4 months (range 1.3–118). Survival after recurrence ranged from 0–93.2 months (six patients are currently alive). A significant increase in the use of chemotherapy was observed rising from 10% prior to 1999 (n=100) to 23% (n=236) after 1999. The median survival for patients receiving chemotherapy (n=64) was 10.6 months (range 1.5–75.7), patients undergoing nonchemotherapy palliative intervention (n=142) median survival was 2.85 months (range 0–93.2), and for patients having no active intervention (n=130), median survival was 1.3 months (range 0–16.2). Median duration of chemotherapy was 3.1 months (range 0.5–9.2). Median survival for these patients after chemotherapy treatment was 6.6 months (range 0.4–73.5). Twenty-eight patients (44%) experienced side effects of chemotherapy. Ten cases required treatment to be modified or stopped and two patients died during chemotherapy. S. J. Amonkar : M. Irving : J. Wayman : T. Sriram : S. M. Griffin : J. J. Nicoll : S. A. Raimes Northern Oesophago-Gastric Cancer Unit, Newcastle upon Tyne & Carlisle, UK S. A. Raimes (*) Cumberland Infirmary, Newtown Road, Carlisle CA2 7HY, UK e-mail: [email protected]
Conclusion There has been a significant increase in the use of palliative chemotherapy for recurrent EG cancer. While survival appears improved, a substantial proportion of this time was spent receiving chemotherapy with many patients experiencing significant comorbidity. Further studies assessing both quality and quantity of life are required to fully evaluate the use of palliative chemotherapy and to identify patients most likely to benefit. Keywords palliative chemotherapy . recurrence . esophageal . gastric . cancer
Introduction Most patients with esophageal and gastric cancer present at an advanced stage of the disease. Surgery offers a chance of cure for those with localized disease. Unfortunately, the majority of patients who are fit for radical surgery will go on to develop recurrent disease. Chemotherapy remains an option for symptom palliation and further active treatment for patients who develop recurrent esophagogastric (EG) cancer, particularly when disease is multifocal. It is considered in conjunction with other treatment strategies for local disease recurrence and distant metastatic spread for esophageal and gastric canc
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