Survival Impact of Delaying Postoperative Radiotherapy in Patients with Esophageal Cancer

Abstract

The purpose of the current study was to retrospectively assess the effect of postoperative radiotherapy (RT) delay on survival for patients with esophageal cancer. From 2008 to 2011, patients with esophageal cancer who had undergone postoperative RT in five different hospitals in China were reviewed. Clinical data, including time interval between surgery to RT, were prospectively collected. Kaplan-Meier method was conducted to estimate the effect of each variable on progression-free survival (PFS) and overall survival (OS), with differences assessed by log-rank test. Univariate Cox proportional-hazards models were performed for both PFS and OS for all assumed predictor variables. Statistically significant predictor variables (P < .05) on univariate analysis were then included in multivariate Cox proportional-hazards models, which were performed to compare the effects of RT delay on PFS and OS. A total of 316 patients were finally enrolled in this prospectively multicentric study. Time to RT after surgery varied from 12 days to over 60 days (median, 26 days). Multivariate analysis showed that delay to RT longer than the median does not appear to be a survival cost. There was also no statistically difference in PFS (P = .513) or OS (P = .236) between patients stratified by quartiles (≤21 days vs ≧35 days). However, patients with particularly long delays (≧42 days) demonstrated a detrimental impact on OS (P = .021) but not PFS (P = .580). Delaying postoperative RT of esophageal cancer does not impact PFS, but results in a significant reduction on OS if delaying longer than 6 weeks.

Delayed postoperative radiotherapy might improve the long-term prognosis of locally advanced esophageal squamous cell carcinoma

“…In another retrospective study, Wang et al. reported that a delay in initiating PORT of longer than 26 days did not appear to have a survival cost, but a delay of longer than 42 days had a detrimental impact on OS [11] . The inconsistencies in the above results and those of our study may be attributable to differences in both patient composition and confounding factors.…”

“…Two studies have previously attempted to explore the influence of the time interval between surgery and PORT on the survival of patients with esophageal cancer [11 , 12] . A retrospective study by Yamada et al.…”

“…Studies on the effects of the time interval between radiotherapy and surgery for esophageal cancer have mainly focused on the interval between neoadjuvant radiotherapy and surgery [8] , [9] – 10] . Few studies have explored the effects of the interval between surgery and PORT [11 , 12] , and important confounding factors such as the number of lymph nodes removed and the sequence of postoperative adjuvant treatments, which may account for prognostic differences, have been ignored. Although the interval between surgery and PORT has been more thoroughly studied for other malignancies, the results obtained have been mixed [13] , [14] , [15] .…”

<p>Postoperative Radiotherapy for Thoracic Esophageal Carcinoma with Upfront R0 Esophagectomy</p>

“…Another multicenter retrospective study also assessed the effect of PORT delay on survival for 316 patients. 62 In this study, the waiting period after surgery varied from 12 days to over 60 days (median, 26 days).…”

“…Another multicenter retrospective study also assessed the effect of PORT delay on survival for 316 patients. 62 In this study, the waiting period after surgery varied from 12 days to over 60 days (median, 26 days). Patients with a particularly long waiting period (≥42 days) demonstrated a detrimental impact on OS (P=0.021) but not PFS (P=0.580).…”