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

Abstract

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.

The Management and Prognostic Prediction of Adenocarcinoma of Appendix

“…It should be noted that multidisciplinary therapies, especially surgical resection followed by adjuvant chemoradiation therapy, have been increasingly applied for the treatment of suitable patients with resectable digestive tract cancers16171819. However, whether multidisciplinary therapies could improve overall survival in patients with adenocarcinoma of the appendix remains uncertain.…”

Perfil dos Pacientes com Câncer de Esôfago Diagnosticados entre 2001 e 2010 no Brasil

“…O câncer de esôfago é uma doença com prognóstico ruim 4,8 , e apenas um pequeno grupo de pacientes é candidato a tratamento com finalidade curativa [9][10] . Com o intuito de aumentar a sobrevida e minimizar as complicações do tratamento, estratégias utilizando a radioterapia e a combinação de radioterapia à quimioterapia têm despertado o interesse da comunidade científica [10][11] .…”

“…Para outras populações, onde foi observada maior frequência de câncer de esófago entre os homens, de raça negra, com idade superior a 60 anos e de baixa escolaridade [6][7][8][9][17][18][19][20][21][22][23] . O consumo de tabaco e álcool também são mais frequentes nessa população, o que pode justificar a maior presença de câncer em pessoas com essas características 5,21 .…”

“…A ausência de sintomas em fases inicias faz com que, em sua maioria, o diagnóstico seja realizado em fases mais avançadas 16 , o que torna esse câncer altamente letal 18 . Neste estudo, 68,2% dos pacientes foram diagnosticados em estádio avançado, dados similares aos encontrados em outras populações, o que gerou tratamentos mais agressivos, maior frequência de complicações relacionadas à terapêutica oncológica e pior prognóstico [3][4]9,[12][13] .…”

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

“…28 Population-level data from the Surveillance, Epidemiology, and End Results registry have also demonstrated an association between receipt of radiotherapy and OS in metastatic esophageal cancer. 29 However, this analysis was limited by the lack of data regarding receipt of chemotherapy in the study population as well as by the limited details on radiation treatment, including dose. The current study represents the largest and most statistically rigorous comparison of survival outcomes in patients with metastatic esophageal cancer treated with aggressive primary tumordirected therapy and it is the first to our knowledge to evaluate the impact of radiation dose in this context.…”