Definitive radiochemotherapy in esophageal cancer - a single institution experience

Abstract

BackgroundDefinitive radiochemotherapy is the preferred treatment option in patients with the cancer of the cervical esophagus and a viable treatment option in patients with the cancer of lower two thirds of the esophagus, who decline proposed surgical treatment. The purpose of the study was to evaluate the treatment results with definitive radiochemotherapy of patients with esophageal cancer, treated in a single institution in the period from 2010 to 2017.Patients and methodsAll available medical data for 55 patients with esophageal cancer, who were treated with definitive radiochemotherapy with curative intent, were analyzed retrospectively. Patients were irradiated to a total dose to the tumor of 70 Gy (2 Gy per fraction) in upper third (cervical) tumors or to the mean total dose of 57.6 Gy (1.8 Gy per fraction) in middle third (intrathoracic) tumors. All but one patient received concomitant chemotherapy, with the majority of them (41 patients; 74.5%) receiving concomitant chemotherapy with 5-fluorouracil in continuous 96 hours infusion and cisplatin. The main endpoints of the study were overall survival (OS; death of any cause), locoregional control (LRC; local and/or regional disease recurrence) and disease-free survival (DFS; recurrence of any kind and/or new primary malignoma). Univariate analysis testing the impact of different parameters on survivals and analysis of treatment related side effects were performed as well.ResultsThe mean age of patients was 62 years (SD 9 years; range: 29–80 years). Majority of them had squamous cell cancer (53 patients; 96.4%) in the stage T3 or T4 (47 patients; 85.5%) and/or N+ disease (35 patients; 63.6%). Median follow-up time for the whole group of patients was 16.8 months (range: 0.3–81.8 months). At the time of analysis 14 (25.5%) patients were still alive. Rates for OS, LRC and DFS at two and five years were as follows: 47% and 19.4%; 43.7% and 41%; 32.1% and 11.5%, respectively.ConclusionsThe study results of treatment with definitive radiochemotherapy in patients with esophageal cancer are similar to the results of other studies. Majority of patients ended the treatment according to the protocol, which at least in part can be attributed to the adequate and well organized supportive treatment in our institution.

Analysis of the Risk Factors for Negative Emotions in Patients with Esophageal Cancer During the Peri-Radiotherapy Period and Their Effects on Malnutrition

“… 20 Radiotherapy is an effective treatment strategy for esophageal cancer and considerably prolongs the survival of patients. 6 , 7 , 21 Patients with esophageal cancer who are administered radiotherapy are prone to negative emotions, anxiety, and depression during treatment, which can greatly affect the postoperative recovery and prognosis, thus reducing the effectiveness of treatment and the quality of life of patients. Additionally, several studies have shown that depression and anxiety are significantly higher in patients with esophageal cancer than in the general population and in patients with other types of cancer.…”

“…4,5 Radiotherapy is an effective method of treating EC and considerably prolongs the survival of patients. 6,7 However, radiotherapy has toxic side effects in patients and might also lead to malnutrition. 8 Long-term malnutrition reduces the quality of life of patients and their tolerance to radiotherapy and decreases treatment sensitivity, resulting in prolonged hospitalization or shortened survival time, or in severe cases, treatment failure due to lack of tolerance.…”

Effect of perioperative flurbiprofen axetil on long‐term survival of patients with esophageal carcinoma who underwent thoracoscopic esophagectomy

“…7 Similarly, a large number of studies have confirmed that postoperative radiotherapy can significantly improve the OS rate and RFS rate of patients with esophageal cancer. 8 Fourth, in our opinion, tumor location should be considered in this study. Studies have shown that the survival rate of tumors located in the upper, middle, and lower esophagus is different, the prognosis of upper esophageal cancer is worse than that of middle esophagus and lower esophagus.…”