Outcomes and prognostic factors for patients with cervical esophageal cancer undergoing definitive radiotherapy or chemoradiotherapy

Abstract

Cervical esophageal cancer (CEC) is uncommon, accounting for less than 5% of all esophageal cancers. The management of CEC is controversial. This study investigated treatment outcomes and prognostic factors of survival in CEC patients undergoing definitive radiotherapy or concurrent chemoradiotherapy (CCRT). Ninety-one CEC patients were treated by intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiation therapy (3DCRT) between July 2007 and September 2017. The mean prescription dose was 64 Gy (range 54-70 Gy) delivered as 1.8-2.2 Gy per fraction per day, 5 days a week. Out of 91 patients, 34 received concurrent cisplatin-based chemotherapy (CT) including 18 patients who also received neoadjuvant CT. Overall survival (OS), locoregional failure-free survival (LRFFS), and progression-free survival (PFS) were estimated by the Kaplan–Meier method. Prognostic factors of survival were determined in univariate (log-rank test) and multivariate (Cox proportional hazard model) analysis. Treatment-related toxicity was also assessed. Median follow-up time for all patients was 19 months. Two-year OS, LRFFS and PFS of all patients were 58.2%, 52.5% and 48.1%, respectively. Clinical stage was an independent prognostic factor for OS (HR = 2.35, 95% CI: 1.03-5.37, p = 0.042), LRFFS (HR = 3.84, 95% CI: 1.38-10.69, p = 0.011), and PFS (HR = 2.68, 95% CI: 1.11-6.45, p = 0.028). Hoarseness was an independent prognostic factor for OS (HR = 2.10, 95% CI: 1.05-4.19, p = 0.036). CCRT was independently associated with better LRFFS (HR = 0.33, 95% CI: 0.14-0.79, p = 0.012). 3DCRT and IMRT with concurrent CT is well-tolerated and may improve local tumor control in CEC patients. Advanced clinical stage and hoarseness are adverse prognostic factors for OS, LRFFS, and PFS in CEC.

The Application of Nimotuzumab Combined With Definitive Chemoradiotherapy Toward the Treatment of Locally Advanced Cervical Esophageal Carcinoma: A Retrospective Study

“…We also discovered that the application of nimotuzumab might reduce the incidence of anemia, which has not been reported in other previous studies. Multivariate analysis revealed that CEC patients with a higher ECOG score, lower histological grade, and earlier stage had a better OS, which was in accordance with the prior research ( 45 ). Interestingly, our research also found that patients with normal CRP baseline (CRP ≤ 10 mg/L) can achieve better OS than those with CRP >10.…”

<p>Clinical results of intensity-modulated radiotherapy for 250 patients with cervical and upper thoracic esophageal carcinoma</p>

“…Intensity-modulated radiotherapy (IMRT), a radiotherapeutic modality with high conformality and mild side effects, is often used for the treatment of cervical and upper thoracic esophageal cancer. Some studies demonstrate the advantages of IMRT in cervical esophageal cancer 8,9. However, few studies have investigated the outcomes of IMRT in patients with upper thoracic esophageal cancer, and the data regarding the clinical efficacy, failure patterns and prognostic factors for cervical and upper thoracic esophageal cancer patients treated with IMRT are still limited.…”

Surgical outcomes of oro-intestinal continuity reconstruction after total esophagectomy in patients with cervicothoracic malignancy: a thoracic surgeon’s perspective

“…In terms of treatment modality, the prognoses of patients who underwent surgical resection in this study were relatively inferior to those who received definitive chemoradiation therapy for CECs and advanced-stage HNSCC (12,13). However, the patients in this study had more aggressive cancer, such as tracheal or esophageal invasion, compared with those in previous studies (12,13). In addition, some patients in this study underwent salvage operation due to cancer recurrence.…”