Factors Predictive of Improved Outcomes With Multimodality Local Therapy After Palliative Chemotherapy for Stage IV Esophageal Cancer

Wang, Jingya; Suri, J.S.; Allen, Pamela K.; Liao, Zhongxing; Komaki, Ritsuko; Ho, Linus; Hofstetter, Wayne L.; Lin, Steven H.

doi:10.1097/coc.0000000000000066

Cited by 28 publications

(40 citation statements)

References 25 publications

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“…Given the limited of studies with small sample sizes investigating the effect of local treatment in metastatic EC10111213. In this study, we explored the prognostic value of local treatment modalities including CDS and RT in metastatic EC based on 9,125 metastatic EC patients in the SEER database and our results found that surgery plus RT could significantly improve survival in metastatic EC.…”

Section: Discussionmentioning

confidence: 99%

“…RT is not a first-line treatment for metastatic EC, but RT may improve the patients’ symptoms of obstruction9. Studies with small sample sizes have shown that local treatments including surgery could prolong survival in metastatic EC10111213. Studies have shown that surgery and/or radiotherapy can improve survival in patients with stage IV malignant tumors1415.…”

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confidence: 99%

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Surgery Combined with Radiotherapy Improved Survival in Metastatic Esophageal Cancer in a Surveillance Epidemiology and End Results Population-based Study

Xie

Zhang

et al. 2016

Sci Rep

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This retrospective study used a population-based national registry to determine the impact of local treatment modalities on survival in patients with metastatic esophageal cancer (EC). The Surveillance Epidemiology and End Results (SEER) database was used to identify patients with metastatic EC from 1988 to 2012. A total of 9,125 patients were identified. There were 426 patients underwent primary surgery, 4,786 patients were administered radiotherapy (RT) alone, 847 patients underwent surgery plus RT, and 3,066 patients without any local treatment. Multivariate analysis results indicated that year of diagnosis, age, race, histologic subtype, grade, and local treatment modalities were independent prognostic factors for overall survival (OS). The 5-year OS were 8.4%, 4.5%, 17.5%, and 3.4% in primary surgery, RT only, surgery plus RT, and no local treatment, respectively (P < 0.001). Subgroup analyses showed that the impact of RT was mainly reflected by preoperative radiotherapy, as patients received preoperative radiotherapy had significantly better OS than patients who underwent primary surgery alone and postoperative RT, the 5-year OS rates were 24.7%, 6.5%, and 7.8%, respectively, respectively (P < 0.001). Surgery plus RT, especially preoperative RT, may improve long-term survival of patients with metastatic EC.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Surgery Combined with Radiotherapy Improved Survival in Metastatic Esophageal Cancer in a Surveillance Epidemiology and End Results Population-based Study

Xie

Zhang

et al. 2016

Sci Rep

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“…The worldwide standard of total 50.4 Gy irradiation for esophageal cancer without distant metastasis was used, and treatment was given with palliative intent, so the radiation dose of 50 Gy was thought to be reasonably safe. Previous studies have investigated age, distant metastasis, baseline white blood cell count, change in standardized uptake value in PET after chemotherapy, lack of anorexia/cachexia, and lack of widely disseminated disease as predictors of OS (26,27). We found that a small group of eight patients who underwent surgery after CCRT had more favorable OS than that of patients who did not have surgery.…”

Section: Discussionmentioning

confidence: 59%

Clinical results of multimodality therapy for esophageal cancer with distant metastasis

et al. 2018

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Background: The purpose of this study is to evaluate outcomes in upfront local response and survival of patients with esophageal cancer and distant metastasis. Methods: This retrospective study included 34 patients (25 males) aged 42-92 years (median, 70 years) with a histological diagnosis of esophageal squamous cell cancer with distant metastasis. Staging was performed according to the UICC's TNM (6th edition) classification of malignant tumor. Results:The median survival time (MST) was 5 months. The 1-year overall survival (OS) was 20.6%.Improved OS was associated with receipt of surgery [hazard ratio (HR), 3.857; 95% CI, 1.142-13.024; P=0.030] on both univariate and multivariate analyses, and the MST was 11 months. The overall objective local response rate was 82%. Ten patients had complete response (CR), 18 had partial response (PR). The overall symptom response was 88% patients. Six had CR, 24 had PR. There was no significant difference in the objective and symptom response between ≤50 and >50 Gy. Concurrent chemoradiotherapy (CCRT) with 50 Gy gave results of objective and symptom responses comparable to those of 60 Gy, which has been reported previously. Conclusions: CCRT with 50 Gy gave results comparable to those of 60 Gy, which has been reported previously, and the toxicity was acceptable. Our findings showed that a multimodality therapy that includes surgery may improve survival in only a select group.

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“…These findings are closely mirrored by Gandy et al [23], with a 60% 5-year OS after liver resection in a cohort of 48 patients, 2 of which were affected by liver OEC. In a retrospective study including 96 patients, Wang et al [15] reported that a small subset of 14 patients who were treated with a multimodal approach including liver resection showed a more favorable prognosis compared to patients who did not undergo surgery. Similarly, Carmona-Bayonas et al [24] reported that 92 patients who underwent surgery for EC metastasis had a higher survival rate than patients who did not undergo metastasectomy (30% versus 8%).…”

Section: Surgerymentioning

confidence: 99%

“…Alternative therapeutic options generally include CHT and loco-regional therapies. More recently, small trials have reported that patients with low hepatic tumor burden have a favorable prognosis after CHT followed by liver resection [9,[14][15][16]. Indeed, the prognosis of patients with non-surgically treated liver OEC still remains largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Management of Liver Oligometastatic Esophageal Cancer: Overview and Critical Analysis of the Different Loco-Regional Treatments

Procopio

Maranò

Gentile

et al. 2019

Cancers

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Esophageal cancer (EC) is an aggressive disease that is associated with a poor prognosis. Since metastastic EC is usually considered suitable only for palliative therapy with an estimated 5-year overall survival (OS) less than 5%, the optimal management of patients with liver oligometastatic EC (LOEC) is still undefined. The aim of this review is to provide an overview of the different treatment options for LOEC. A literature search was conducted using PubMed, Embase, and Cochrane to identify articles evaluating different treatment strategies for LOEC. Among 828 records that were identified, 20 articles met the inclusion criteria. These studies included patients who have undergone any type of surgical procedure and/or loco-regional therapy. Liver resection resulted in the best survival for patients with low tumor burden (3 lesions): 5-year OS 30-50% versus 8-12% after only chemotherapy (CHT). The 5-year OS of loco-regional therapies was 23% with a local recurrence risk ranging 0-8% for small lesions (2 to 3 cm). An aggressive multidisciplinary approach for LOEC patients may improve survival. Surgery seems to be the treatment of choice for resectable LOEC. If unfeasible, loco-regional therapies may be considered. In order to better select these patients and offer a chance of cure, prospective trials and a definition of treatment protocols are needed.

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Factors Predictive of Improved Outcomes With Multimodality Local Therapy After Palliative Chemotherapy for Stage IV Esophageal Cancer

Abstract: Aggressive local therapy with radiation and potentially surgery after initial palliative chemotherapy can improve prognosis for a select group of patients with stage IVB esophageal cancer.

Cited by 28 publications

References 25 publications

Surgery Combined with Radiotherapy Improved Survival in Metastatic Esophageal Cancer in a Surveillance Epidemiology and End Results Population-based Study

Surgery Combined with Radiotherapy Improved Survival in Metastatic Esophageal Cancer in a Surveillance Epidemiology and End Results Population-based Study

Clinical results of multimodality therapy for esophageal cancer with distant metastasis

Management of Liver Oligometastatic Esophageal Cancer: Overview and Critical Analysis of the Different Loco-Regional Treatments

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