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Surgical resection is the current standard treatment for patients with early stage cancer of the esophagus. In a subset of these patients, comorbidities prohibit the operative risks of a potentially curative esophagectomy. Such patients may be candidates for local endoscopic treatment. We sought to look at a large cohort of patients with clinically localized esophagus cancer to determine whether high-risk patients survive significantly longer after endoscopic therapy than those who receive no local treatment. T0 or T1, N0 esophageal cancer (EC) patients who did not receive surgery or radiation were identified from the Surveillance, Epidemiology, and End Results cancer registry (1998-2003). The patients were assigned into two groups: local endoscopic therapy (excisional biopsy, photodynamic, local destruction, thermal laser, polypectomy, electrocautery, or cryoablation) versus no endoscopic therapy. Differences in survival were calculated using the Kaplan-Meier method, and a multivariate Cox regression analysis adjusting for potential confounders was used to analyze the effect of local therapy on survival. The study cohort included 166 T0 or T1, N0 EC patients. (75% male; 50% >70 years old). Tumors were adenocarcinoma (60%), squamous cell carcinoma (24%), and other (16%). The 4-year disease-specific survival rate was 84% for patients receiving local therapy compared with 64% for patients receiving no therapy (P < 0.01). On multivariate analysis, patients receiving local therapy had a significantly lower hazard of EC-related death (P = 0.04). There was no difference in survival curves for deaths secondary to causes other than EC. Local endoscopic therapy significantly prolonged survival in high-risk patients with clinical T0 or T1, N0 EC and is a reasonable alternative for those patients who are not candidates for potentially curative esophagectomy.

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Purpose-Complex radiotherapy (RT) planning is increasingly common in the treatment of lung cancer though it remains unclear if these treatments are associated with better outcomes. We evaluated the association between the complexity of RT planning simulation with survival among elderly Stage IIIB non-small cell lung cancer (NSCLC) patients.Methods-We included all patients aged >65 years with histologically confirmed Stage IIIB NSCLC diagnosed between 1992 and 2002 receiving chemotherapy and RT from the Surveillance, Epidemiology, and End Results registry linked to Medicare claims. Patients were divided into simple, intermediate, and complex RT planning groups using Medicare physician codes. KaplanMeier curves and Cox regression were used to compare overall and lung cancer-specific survival rates across groups.Results-We identified 1,733 patients: 148 (8%), 1,138 (66%), and 447 (26%) were classified as having received simple, intermediate and complex RT planning, respectively. Baseline characteristics were similar across groups. Increasing complexity of RT planning was significantly associated with better overall survival (p=0.0002). Multivariate analyses showed that intermediate (HR: 0.75, 95% CI: 0.62 to 0.91) and complex planning (HR: 0.69, 95% CI: 0.55 to 0.86) were associated with better overall survival compared to simple RT planning. Similar results were observed for lung cancer-specific survival analyses. Toxicities were comparable across groups.Conclusions-The use of more complex RT planning and simulation methods is associated with better survival in elderly patients with Stage IIIB NSCLC. Although these results should be further validated in prospective clinical trials, this data suggests that complex planning may improve the outcomes of these patients.

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