Improved Overall Survival with Aggressive Primary Tumor Radiotherapy for Patients with Metastatic Esophageal Cancer

Abstract

Definitive dose, but not conventional palliative dose, PTDRT is associated with improved overall survival in metastatic esophageal cancer, suggesting that local control may be important to prognosis. These findings support integrating PTDRT into future clinical trials aimed at refining personalized treatment for patients with metastatic esophageal cancer.

Sites of metastasis and overall survival in esophageal cancer: a population-based study

“…Several retrospective and prospective studies have suggested that palliative radiotherapy could improve survival in metastatic EC. 27 – 29 In addition, several recent retrospective studies found that resection of primary tumors may be considered for a select group of patients with stage IV EC who achieve a favorable response to systemic chemotherapy. 18 , 19 , 30 Our previous study of the SEER database also found that surgery and preoperative radiotherapy were associated with better survival in metastatic EC.…”

Definitive local therapy is associated with improved overall survival in metastatic cervical cancer

“…The concept that eradication of the primary tumor can improve long-term outcomes in the metastatic setting was first demonstrated prospectively in patients with renal cell carcinoma. 7,8 Since then, a large body of retrospective data studying esophageal, 6 bladder, 9 and prostate cancers 10 has demonstrated an association between definitive treatment of the primary site and improved OS. Such studies in cervical cancer are extremely limited and primarily focus on patients with recurrent metastatic disease after prior definitive treatment.…”

“…Despite these limitations, our findings are mechanistically plausible and concordant with results demonstrated in similar studies of other malignancies. [6][7][8][9][10]…”

“…4,5 Systemic therapy alone is often insufficient to control such consequences of local progression and additional local therapy such as radiation therapy or surgery is commonly required to mitigate the impact of progressive disease at the primary site. 4 Studies of other malignancies [6][7][8][9][10] suggest a potential survival benefit associated with definitive rather than palliative local therapy directed to the primary site even in the setting of metastatic disease. The benefit of such an approach in metastatic cervical cancer has not been rigorously investigated and may be plausible due to the life-threatening consequences of local tumor progression, even in the setting of disseminated disease.…”

Characteristics and Treatment of Brain Metastases from Esophageal Squamous Cell Carcinoma

“…Similarly, Depypere et al 9 recently reported patients with esophageal cancer and solitary solid organ metastases achieved good median overall survival of 54 months after surgery, which was superior to chemotherapy alone. Guttmann et al found definitive dose radiotherapy was associated with improved survival compared to conventional palliative dose radiotherapy based on analysis of 12683 patients with esophageal cancer 15 . These studies indicate that-similarly to brain metastases-patients with solitary solid organ metastases may achieve better treatment outcomes after definitive local treatment of recurrent lesions.…”