Concurrent chemoradiotherapy with or without surgery for patients with resectable esophageal cancer: An analysis of the National Cancer Data Base. Issue 18 (2nd May 2017)

• Record Type: Journal Article
• Authors: Naik, Kushal B.; Liu, Yuan; Goodman, Michael; Gillespie, Theresa W.; Pickens, Allan; Force, Seth D.; Steuer, Conor E.; Owonikoko, Taofeek K.; Ramalingam, Suresh S.; Higgins, Kristin; Beitler, Jonathan J.; Shin, Dong M.; Willingham, Field F.; El‐Rayes, Bassel; Landry, Jerome C.; Fernandez, Felix G.; Saba, Nabil F.
• Is Part Of: Cancer. Volume 123:Issue 18(2017)
• Page Start: 3476
• Page End: 3485
• Publication Date: 2017-05-02
• Subjects: chemoradiotherapy -- chemotherapy -- databases -- esophageal neoplasms -- esophagectomy -- mortality -- propensity score -- radiotherapy -- survival analysis -- therapeutics; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.30763
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: Patients with resectable esophageal cancer (rEC) are managed with either concurrent chemoradiotherapy followed by surgery (CRSx) or concurrent chemoradiotherapy alone (cCR). To the authors' knowledge, there is insufficient evidence comparing the overall survival of patients treated with these 2 options. METHODS: The National Cancer Data Base was queried for rEC cases diagnosed from 2003 through 2011. Patients with previous cancers, cervical rEC, clinical stage T1N0 disease, or metastasis were excluded. cCR was defined as radiotherapy administered within 30 days of chemotherapy. CRSx was defined as cCR followed by esophagectomy within 90 days. Overall survival was compared using Kaplan‐Meier methods, propensity score matching, and extended Cox proportional hazards models. RESULTS: Of the 11, 122 eligible patients, 8091 (72.7%) received cCR and 3031 (27.3%) received CRSx. The odds of receiving CRSx were higher among patients with American Joint Committee on Cancer stage II disease (vs stage III), adenocarcinoma (vs squamous cell carcinoma), lesions of the lower one‐third of the esophagus, private insurance, and those living >25 miles from the treating facility or in areas with a higher median income or a greater percentage of high school‐educated residents. Patients aged >70 years, female patients, African‐American patients, those with ≥2 comorbidities, or those treated at community programs were more likely to receive cCR. After propensity score matching, the median and 10‐year survival rates were found to be significantly better with CRSx (32.5 months [95% confidence interval (95% CI), 29.6‐34.8 months] and 23.8% months [95% CI, 20.0‐27.9 months], respectively) compared with cCR (14.2 months [95% CI, 13.4‐15.5 months] and 6.1% months [95% CI, 3.9‐9.0 months], respectively). CONCLUSIONS: Data from the National Cancer Data Base support the inclusion of surgery after concurrent chemoradiotherapy for patients with locally advanced rEC. Cancer 2017;123:3476‐85. © 2017 American Cancer Society . Abstract : The current study is a retrospective national registry study of 11, 122 patients with esophageal cancer. Approximately 73% received chemoradiotherapy alone and 27% were treated with chemoradiotherapy followed by surgery. After adjusting for clinical and tumor characteristics, preoperative concurrent chemoradiotherapy followed by surgical resection appears to significantly improve long‐term survival compared with definitive concurrent chemoradiotherapy alone.