A retrospective review of treatment outcomes following definitive chemoradiotherapy or single modality radical radiotherapy among patients with locally advanced esophageal cancer.

Abstract

196 Background: Definitive chemoradiotherapy (CRT) has been advocated as an alternative to surgical resection for the treatment of locally advanced oesophageal cancer (OC). We have retrospectively reviewed 4 years experience of patients (pts) who underwent contemporary staging and were treated with concurrent chemoradiotherapy (CRT) or single modality radical radiotherapy (RT) with curative intent. Methods: Retrospective analysis permitted identification of consecutive pts who underwent contemporary staging prior to non-surgical treatment for oesophageal carcinoma. The primary outcomes were overall (OS) and disease-free survival (DFS), adjusted for baseline differences in age, tumour staging and histological cell type. All patients were treated with either definitive CRT or single modality RT within a single centre treated between 2009 and 2012. Results: We identified 135 pts in total (median age 69.8 yrs, male=130pts, female=105pts, Adenocarcinoma=85pts, Squamous=150pts). 190 pts received CRT and 45pts were treated with RT. All pts were staged with CT of chest, abdomen and pelvis, 226 pts underwent Endoscopic ultrasound (EUS) and 183 pts had PET-CT. Patients treated with CRT demonstrated longer OS (37 versus 25 months, p=0.02) and DFS (31 versus 16 months, p=0.01) compared to those treated with RT. More advanced tumour stage (stage 3 v stage 1-2) at presentation conferred poorer OS (32 versus 38.2 months) and DFS (11 versus 28 months, p=0.013). We demonstrated an acceptable toxicity profile with only 77 pts (32.8%) and 9 pts (4.2%) experiencing grade III or IV CTC toxicities respectively. Conclusions: This retrospective analysis is in keeping with current treatment paradigms emphasising the importance and safety of concurrent CRT in maximising curative potential for pts undergoing non-surgical treatment of oesophageal cancer. Although retrospective, in comparison to similar retrospective series from our centre, our data suggest improvements in OS and DFS, possibly due to improved patient selection through the use of more effective tumour staging.

Single modality radical radiotherapy is an acceptable alternative for the older patient with squamous cell carcinoma of the oesophagus

“…This centre has previously published favourable data on outcomes of radical RT for SCC oesophagus. 13 Here, a review of the over 65 population is specifically addressed.…”