Trends in treatment and overall survival among patients with proximal esophageal cancer

Abstract

BACKGROUNDThe management of proximal esophageal cancer differs from that of tumors located in the mid and lower part of the esophagus due to the close vicinity of vital structures. Non-surgical treatment options like radiotherapy and definitive chemoradiation (CRT) have been implemented. The trends in (non-)surgical treatment and its impact on overall survival (OS) in patients with proximal esophageal cancer are unclear, related to its rare disease status. To optimize treatment strategies and counseling of patients with proximal esophageal cancer, it is therefore essential to gain more insight through real-life studies.AIMTo establish trends in treatment and OS in patients with proximal esophageal cancer.METHODSIn this population-based study, patients with proximal esophageal cancer diagnosed between 1989 and 2014 were identified in the Netherlands Cancer Registry. The proximal esophagus consists of the cervical esophagus and the upper thoracic section, extending to 24 cm from the incisors. Trends in radiotherapy, chemotherapy, and surgery, and OS were assessed. Analyses were stratified by presence of distant metastasis. Multivariable Cox proportional hazards regression analyses was performed to assess the effect of period of diagnosis on OS, adjusted for patient, tumor, and treatment characteristics.RESULTSIn total, 2783 patients were included. Over the study period, the use of radiotherapy, resection, and CRT in non-metastatic disease changed from 53%, 23%, and 1% in 1989-1994 to 21%, 9%, and 49% in 2010-2014, respectively. In metastatic disease, the use of chemotherapy and radiotherapy increased over time. Median OS of the total population increased from 7.3 mo [95% confidence interval (CI): 6.4-8.1] in 1989-1994 to 9.5 mo (95%CI: 8.1-10.8) in 2010-2014 (logrank P < 0.001). In non-metastatic disease, 5-year OS rates improved from 5% (95%CI: 3%-7%) in 1989-1994 to 13% (95%CI: 9%-17%) in 2010-2014 (logrank P < 0.001). Multivariable regression analysis demonstrated a significant treatment effect over time on survival. In metastatic disease, median OS was 3.8 mo (95%CI: 2.5-5.1) in 1989-1994, and 5.1 mo (95%CI: 4.3-5.9) in 2010-2014 (logrank P = 0.26).CONCLUSIONOS significantly improved in non-metastatic proximal esophageal cancer, likely to be associated with an increased use of CRT. Patterns in metastatic disease did not change significantly over time.

Patterns of recurrence following definitive chemoradiation for patients with proximal esophageal cancer

“…In our cohort, only 15% of patients developing distant metastases received palliative chemotherapy. This corresponds to historical data in a large cohort of proximal EC [37], and reflects the limited high level evidence of palliative systemic therapy in metastatic esophageal SCC [38], as well as the frailty of this population.…”

Long-Term Survival Outcomes and Comparison of Different Treatment Modalities for Stage I-III Cervical Esophageal Carcinoma

“…When we compared our study results with those from a recently published retrospective study evaluating 500 Chinese CEC patients, we found a similar distribution of baseline characteristics between Western and Eastern countries ( 24 ). The proportion of patients receiving surgical resection in this unique setting was in accordance with a report from the Netherlands ( 25 ) that included 2,783 patients diagnosed with proximal esophageal cancers. The data revealed that surgical resection was performed in 17% of patients during 1989–1994 and in only 2% during 2010–2014.…”

Randomized Study on Dose Escalation in Definitive Chemoradiation for Patients With Locally Advanced Esophageal Cancer (ARTDECO Study)

“…First, by using weekly concurrent carboplatin and paclitaxel as the chemotherapy backbone rather than cisplatin and fluorouracil, treatment toxicity can be substantially reduced. [13][14][15] Second, by simultaneously integrating the boost dose, a biologically higher effective dose to the tumor can be delivered. Third, by using more modern radiation techniques, such as intensity-modulated techniques (IMRT, volumetric-modulated arc therapy), improved sparing of surrounding tissues can be achieved.…”