e16072 Background: The SEER 5-year overall survival rate for all stages of esophageal cancer (EC) was 25% in 2019. Definitive chemoradiation (CRT) remains the primary treatment approach for locally advanced EC in the US, however, there are data to support use of induction chemotherapy (CT) in addition to CRT, particularly in adenocarcinoma (AC) histology. The purpose of our study was to assess outcomes in EC patients treated with definitive CRT (+/- induction) to determine which prognostic factors predicted for better survival in a recent, real-world cohort of patients, including those with limited stage IV disease. Methods: This retrospective study included Stages II-IVB (AJCC 8th ed.) EC patients treated with definitive CRT (radiation dose of ≥40 Gy and at least two cycles of concurrent CT [+/- induction CT, +/- esophagectomy]) at our institution between 2008 and 2020. To analyze prognostic factors and estimate OS, univariate models (UVA) and a multivariate (MVA) Cox proportional hazards regression model including age, Stage (II, III, IVA, IVB), AC vs. SCC, esophagectomy, ECOG performance status (PS), and induction CT were performed. Results: Of the 183 patients treated with definitive CRT, 18 were stage II, 119 stage III, 21 stage IVA, and 25 stage IVB. There were 45 SCC and 138 AC patients (Table). Prognostic factors associated with prolonged OS on MVA included lower PS (p<0.01) and esophagectomy (p = 0.05). Stage IVA was associated with shorter survival (p<0.01). Induction CT (delivered in 53% of AC, 31% SCC) was associated with improved survival on UVA (p=0.04), but not MVA (p = 0.08). By histology, 5-year survival rate was 42.7% and 18.2% for AC and SCC, respectively. Conclusions: At our institution, those who received an esophagectomy and those with lower ECOG scores had better survival. The 5-year survival rate was higher for AC patients compared to SCC, with more AC patients receiving esophagectomy and induction CT (significant on UVA, but not MVA). The 5-year survival rate for AC in our study was nearly identical to that seen in the CROSS trial (Shapiro et al. 2015) AC cohort but included >25% stage IV patients. This modern cohort also included poor PS (ECOG≥2) patients (9.2% AC and 13.6% SCC), suggesting induction CT, in addition to pre-operative CRT + surgery, may have added benefit in a real-world practice. Thus, further prospective study is needed.[Table: see text]
359 Background: When esophageal cancer (EC) is metastatic at diagnosis, prognosis is poor, with 5-year survival of ̃5%. NCCN guidelines recommend palliative treatment or best supportive care. However, guidelines do not stratify by the extent of metastatic disease. Oligometastatic (oligo) disease has been shown in some cancers to portend better survival and more aggressive treatment options may be appropriate. Preliminary data has shown this may be the case for oligo EC, however, consensus recommendations remain palliative in intent. This study aims to compare overall survival (OS) in oligo EC patients treated with a definitive approach (chemoradiotherapy [CRT]) to those treated with purely palliative intent. Methods: Patients with oligo (any histology, ≤5 metastatic foci) EC treated in a single academic hospital between 2009-2020 were retrospectively analyzed in 2021. Patients were divided into definitive and palliative treatment groups; definitive CRT was defined as radiation therapy >40 Gy and >2 cycles of chemotherapy (CT) (+/- induction CT). OS was calculated by measuring the time from the date of diagnosis to the date of death or last follow-up. Survival curves between groups and by various prognostic factors were compared using the log rank test. Results: Of 77 Stage IVB patients, 35 met the pre-specified oligo definition. Of these, 18 received definitive CRT, and 17 palliative treatment (Table). With a median follow-up of 60.8 months, median OS for definitive CRT and palliative groups were 91.4 and 8.2 months, (p<0.01), translating into 5-year OS of 57.7% (95%CI: 33.5-82.0%) vs. 7.5% (95%CI: 0.0-21.6%), respectively. Prognostic factors correlated with increased OS included lower ECOG performance status (PS) (p<0.01), induction CT (p<0.01), N stage (p<0.01), adenocarcinoma (vs. squamous cell carcinoma) (p<0.05), diagnosis in 2013 or later (p<0.05), younger age (p<0.05), and > lymphocyte-to-monocyte ratio (p<0.05). Factors not associated with OS included neutrophil-to-lymphocyte ratio (p=0.39), T-stage (p=0.9), primary site (GEJ, distal, mid, or cervical) (p=0.07), tumor grade (p=0.83), type of spread (hematogenous, lymphatic, or local invasion) (p=0.69), sex (p=0.22), and HER2 status (p=0.07). Conclusions: Within our population, oligo EC patients treated with definitive CRT had significantly improved OS as compared to those treated with palliative only intent. These results suggest there may be a sub-population of oligo EC that would benefit from more aggressive treatment paradigms; thus, further evaluation is warranted.[Table: see text]
Background: The study of oligometastatic esophageal cancer (EC) is relatively new. Preliminary data suggests that more aggressive treatment regimens in select patients may improve survival rates in oligometastatic EC. However, the consensus recommends palliative treatment. We hypothesized that oligometastatic esophageal cancer patients treated with a definitive approach (chemoradiotherapy [CRT]) would have improved overall survival (OS) compared to those treated with a purely palliative intent and historical controls. Methods: Patients diagnosed with synchronous oligometastatic (any histology, ≤5 metastatic foci) esophageal cancer treated in a single academic hospital were retrospectively analyzed and divided into definitive and palliative treatment groups. Definitive CRT was defined as radiation therapy to the primary site with ≥40 Gy and ≥2 cycles of chemotherapy. Results: Of 78 Stage IVB (AJCC 8th ed.) patients, 36 met the pre-specified oligometastatic definition. Of these, 19 received definitive CRT, and 17 received palliative treatment. With a median follow-up of 16.5 months (Range: 2.3–95.0 months), median OS for definitive CRT and palliative groups were 90.2 and 8.1 months (p < 0.01), translating into 5-year OS of 50.5% (95%CI: 32.0–79.8%) vs. 7.5% (95%CI: 1.7–48.9%), respectively. Conclusions: Oligometastatic EC patients treated with definitive CRT benefited from that approach with survival rates (50.5%) that vastly exceeded historical standards of 5% at 5 years for metastatic EC. Oligometastatic EC patients treated with definitive CRT had significantly improved OS compared to those treated with palliative-only intent within our cohort. Notably, definitively treated patients were generally younger and with better performance status versus those palliatively treated. Further prospective evaluation of definitive CRT for oligometastatic EC is warranted.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.