Palliative Treatment Utilization and Outcomes in Elderly Patients with Locally Advanced Esophageal Carcinoma: A Review of the National Cancer Database

Abstract

(75% IMPT, 78% IMRT). There was no significant difference in number of pts who underwent surgery (47% IMPT, 56% IMRT) and of those, no difference in pathologic complete response rates (33% IMPT, 39% IMRT). Post-operative complications were also similar between groups including pneumonia, anastomotic leak, anastomotic stricture, and cardiac arrhythmia rates. At one year, clinical outcomes were (for IMPT vs IMRT, respectively): local control 92 vs 84%, local-regional control 92 vs 80%, distant metastasis-free survival 87 vs 65%, and overall survival 74 vs 71% (none statistically significant between groups). IMPT pts had statistically significantly improved progression free survival (PFS) (75% vs 47%, PZ0.02), and it remained significant for improved PFS in the final MVA model (PZ0.04). No statistically significant association was seen between the two groups for acute treatment-related grade 3 toxicities (PZ0.47). Conclusion: We report early, promising retrospective evidence for safety and efficacy of IMPT compared to IMRT for EC. Direct comparative studies of IMPT vs. IMRT utilizing prospective trials accruing larger, balanced patient cohorts are warranted in the future.