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Outcomes of post-cricoid, upper cervical and thoracic oesophageal cancer treated with radical non-surgical treatment: an indian experience

In Clinical Oncology
By: Laskar S.
Contributor(s): Mishra S | Chandre M | Agarwal JP | Kumar S | Prabhash KR | Noronha V | Joshi A | Pramesh CS | Karimundackal G | Jiwnani S.
Material type: materialTypeLabelArticlePublisher: London : W.B. Saunders, 2017Description: .Subject(s): Oesophageal cancer In: Clinical Oncology Vol. 29, no. 3, p.e79Summary: Aims: Carcinoma of the oesophagus carries a guarded prognosis as clinical silence in early disease leads to most patients presenting in advanced stages. Methods: Between January 2000 and March 2012, 333 consecutive patients diagnosed with post-cricoid, upper cervical and thoracic oesophageal cancer and deemed unsuitable for surgery on the grounds of performance status, bulky local disease or personal choice and received (chemo)radiotherapy were included in this retrospective analysis. Demographic, disease, treatment and outcomes data were extracted from patient case files and hospital medical records. Univariate and multivariate analyses were performed to determine the association between patient and disease factors and prognosis. Results: The median follow-up time was 12 months (range 1e148 months, IQR). The disease-free survival (DFS) and overall survival (OS) at 2 years for the whole group was 43% and 52% with a median DFS and OS of 18 months and 27 months, respectively. At last follow-up, 49% had experienced locoregional relapse. On univariate analysis, dose >60 Gy (P ¼ 0.001), conformal technique (P ¼ 0.013), complete response (P ¼ 0.00001) were favourable prognostic factors for OS, whereas KPS > 70(0.000), T1-2 tumours (P ¼ 0.0008), N0 stage (P ¼ 0.023), squamous histology (P ¼ 0.004) and chemotherapy administration (0.016) were favourable factors for DFS. On multivariate analysis, dose >60 Gy (P ¼ 0.011) and complete treatment response (P ¼ 0.00001) had a positive impact on OS, whereas T stage (0.036), N stage (0.029) and histology (P ¼ 0.032) were independent prognostic factors for DFS. 78% of patients completed their planned treatment without any interruptions, 10% (33) of patients were hospitalised during treatment but completed planned treatment after recovery from electrolyte imbalance or febrile neutropenia; 0.06% (2) of patients died on treatment. Conclusion: Definitive (chemo)radiotherapy for unresectable oesophageal cancer can result in an acceptable locoregional control with acceptable toxicity. T stage, N stage and histology influenced DFS. Response after treatment and total radiation dose are important prognostic factors influencing OS Multimodality protocols continue to emerge in an attempt to improve outcomes. Definitive (chemo)radiotherapy is employed in oesophageal cancer patients as an alternative for patients considered medically unfit for surgery or having unresectable tumours. The aim of this study was to determine the outcomes of radical, non-surgical approaches of (chemo) radiotherapy.
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Articles Articles Tata Memorial Hospital
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Pulished in Abstracts / Clinical Oncology 29 (2017) e72ee83

Aims: Carcinoma of the oesophagus carries a guarded prognosis as clinical
silence in early disease leads to most patients presenting in advanced stages. Methods: Between January 2000 and March 2012, 333 consecutive patients
diagnosed with post-cricoid, upper cervical and thoracic oesophageal cancer
and deemed unsuitable for surgery on the grounds of performance status,
bulky local disease or personal choice and received (chemo)radiotherapy
were included in this retrospective analysis. Demographic, disease, treatment
and outcomes data were extracted from patient case files and hospital
medical records. Univariate and multivariate analyses were performed to
determine the association between patient and disease factors and prognosis.
Results: The median follow-up time was 12 months (range 1e148 months,
IQR). The disease-free survival (DFS) and overall survival (OS) at 2 years for
the whole group was 43% and 52% with a median DFS and OS of 18 months
and 27 months, respectively. At last follow-up, 49% had experienced
locoregional relapse. On univariate analysis, dose >60 Gy (P ¼ 0.001),
conformal technique (P ¼ 0.013), complete response (P ¼ 0.00001) were
favourable prognostic factors for OS, whereas KPS > 70(0.000), T1-2 tumours
(P ¼ 0.0008), N0 stage (P ¼ 0.023), squamous histology (P ¼ 0.004) and
chemotherapy administration (0.016) were favourable factors for DFS. On
multivariate analysis, dose >60 Gy (P ¼ 0.011) and complete treatment
response (P ¼ 0.00001) had a positive impact on OS, whereas T stage (0.036),
N stage (0.029) and histology (P ¼ 0.032) were independent prognostic factors
for DFS. 78% of patients completed their planned treatment without any
interruptions, 10% (33) of patients were hospitalised during treatment but
completed planned treatment after recovery from electrolyte imbalance or
febrile neutropenia; 0.06% (2) of patients died on treatment.
Conclusion: Definitive (chemo)radiotherapy for unresectable oesophageal
cancer can result in an acceptable locoregional control with acceptable
toxicity. T stage, N stage and histology influenced DFS. Response after treatment
and total radiation dose are important prognostic factors influencing OS
Multimodality protocols continue to emerge in an attempt to improve outcomes.
Definitive (chemo)radiotherapy is employed in oesophageal cancer
patients as an alternative for patients considered medically unfit for surgery
or having unresectable tumours. The aim of this study was to determine the
outcomes of radical, non-surgical approaches of (chemo) radiotherapy.

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