Outcome of proximal esophageal cancer after definitive combined chemo-radiation: a Swiss multicenter retrospective study

Abstract

ObjectiveTo report oncological outcomes and toxicity rates, of definitive platin-based chemoradiadiationtherapy (CRT) in the management of proximal esophageal cancer.MethodsWe 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.ResultsWe 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 <0.006) and ICHT (p < 0.004) were statistically significant positive predictive factors influencing DFS and OS.ConclusionDefinitive CRT is a reliable therapeutic option for proximal esophageal cancer, with acceptable treatment related toxicities. Higher doses and ICHT may improve OS and DFS and. These findings need to be confirmed in further prospective studies.

A national study to assess outcomes of definitive chemoradiation regimens in proximal esophageal cancer

“…To the best of our knowledge, this is the largest study comparing Cis-versus CP-based CRT, with RT dose-escalation regimens in patients with proximal EC in a curative treatment approach. OS data in our cohort is consistent with results of previous observational studies in cervical or proximal EC exploring the effects of CRT, with 3-year OS rates of about 35-45% [33][34][35][36][37][38][39]. Recently, a small retrospective single institutional Korean study exploring the impact of radiation dose escalation on OS showed more favorable 3-year OS rates compared to the results in the current study, with 58% in the high-dose RT (59.4 Gy) and 49% of patients in the low-dose RT group (<59.4 Gy, p ¼ .69) [40].…”

Long-term outcome of definitive radiotherapy for cervical esophageal squamous cell carcinoma

“…Radiotherapy is a definitive treatment for cervical esophageal squamous cell carcinoma (CESCC). The total doses of definitive radiotherapy for CESCC range from 50 to 70 Gy [ 1 – 10 ]. Chemotherapy was concurrently administered in 28%–100% of patients [ 1 – 5 , 7 – 12 ].…”

Surgical treatment of esophageal cancer in the era of multimodality management

“…Patients with proximal esophageal tumors are usually poor candidates for surgery because of limitations in surgical techniques (e.g., confined working space and poor overview) . Furthermore, due to its anatomical proximity to the hypopharynx, surgery includes a combined pharyngo‐laryngo‐esophagectomy in some cases, resulting in permanent tracheostomy and affecting the quality of life of these patients enormously . Thus, these patients frequently depend on definitive chemoradiotherapy with encouraging 3‐year outcomes and acceptable toxicity …”

“…12 Furthermore, due to its anatomical proximity to the hypopharynx, surgery includes a combined pharyngo-laryngo-esophagectomy in some cases, resulting in permanent tracheostomy and affecting the quality of life of these patients enormously. 13 Thus, these patients frequently depend on definitive chemoradiotherapy with encouraging 3-year outcomes and acceptable toxicity. 13 Comorbidity Accurate patient selection for surgery does not only depend on tumor characteristics, but also on assessment of comorbidities, patient nutritional status, and cardiopulmonary function.…”

“…13 Thus, these patients frequently depend on definitive chemoradiotherapy with encouraging 3-year outcomes and acceptable toxicity. 13 Comorbidity Accurate patient selection for surgery does not only depend on tumor characteristics, but also on assessment of comorbidities, patient nutritional status, and cardiopulmonary function.…”