Influence of Chemoradiotherapy Strategies and Factors on the Five-Years Survival of Patients with Esophageal Cancer

Document Type : Original Article (s)

Authors

1 PhD By Research Student, Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

2 Professor, Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

3 Assistant Professor, Department of Radiology and Radiotherapy, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

4 Assistant Professor, Department of Physiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

5 Associate Professor, Department of Radiology and Radiotherapy, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

6 Radiotrapist, Department of Radiology and Radiotherapy, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

7 Researcher, Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Background: Iran is one of the areas with higher incidence of esophageal cancer in the world. The survival benefit of surgery followed by adjuvant therapy has been demonstrated and widely accepted as a standard therapy in other gastrointestinal malignancies. Definitive chemoradiotherapy (DCRT) is used for locally advanced esophageal cancer and for inoperable tumors, thus is an alternative to surgical treatment. The purpose of the current study was to evaluate the effects of definitive and adjuvant therapy on survival of patients with esophageal cancer.Methods: This retrospective study was conducted in North-West of Iran during 2006-2011, included 331 consecutive patients with esophageal cancer referred to Radiation Oncology Therapy Center of Imam Reza (AS) Hospital in Tabriz, Iran. Health status of patients was followed by telephone contact. Survival rate and the impact of demographic characteristics, treatment modulatory and chemoradiotherapy factors in survival rate was analyzed using Kaplan-Meier Life Table and Cox regression test in SPSS software.Findings: Median survival was 14.2 months (CI 95%: 16.6-12.33). The 1, 3 and 5-year overall survival rates of all patients were 60, 21 and 16%, respectively. The factors influencing survival rate were age at diagnosis (P < 0.001), stage of disease (P < 0.001), tumor differentiation (P = 0.020), treatment modulatory (P < 0.001), radiation dose (P = 0.010), and type of drugs used in chemotherapy (P = 0.010). Among those six significant variables, independent prognostic factor for survival determined via multivariate analysis, was the radiation dose.Conclusion: The results of this study indicate that survival rates of esophageal cancer in our patients are poor. Early detection and improved treatment methods via clinical trials would help to extend the life of patients in the future.

Keywords

References

  1. Islami F, Kamangar F, Aghcheli K, Fahimi S, Semnani S, Taghavi N, et al. Epidemiologic features of upper gastrointestinal tract cancers in Northeastern Iran. Br J Cancer 2004; 90(7): 1402-6.
  2. Earlam R, Cunha-Melo JR. Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surg 1980; 67(6): 381-90.
  3. Whyte RI, Orringer MB. Surgery for Carcinoma of the Esophagus: The Case for Transhiatal Esophagectomy. Semin Radiat Oncol 1994; 4(3): 146-56.
  4. Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 1996; 335(7): 462-7.
  5. Xiao ZF, Yang ZY, Miao YJ, Wang LH, Yin WB, Gu XZ, et al. Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy: report of 549 cases. Int J Radiat Oncol Biol Phys 2005; 62(1): 82-90.
  6. Fok M, Sham JS, Choy D, Cheng SW, Wong J. Postoperative radiotherapy for carcinoma of the esophagus: a prospective, randomized controlled study. Surgery 1993; 113(2): 138-47.
  7. Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001; 19(2): 305-13.
  8. Albertsson M1, Ewers SB, Widmark H, Hambraeus G, Lillo-Gil R, Ranstam J. Evaluation of the palliative effect of radiotherapy for esophageal carcinoma. Acta Oncol 1989; 28(2): 267-70
  9. Earlam R, Cunha-Melo JR. Oesophogeal squamous cell carcinoms: II. A critical view of radiotherapy. Br J Surg 1980; 67(7): 457-61.
  10. Sun DR. Ten-year follow-up of esophageal cancer treated by radical radiation therapy: analysis of 869 patients. Int J Radiat Oncol Biol Phys 1989; 16(2): 329-34.
  11. Okawa T, Kita M, Tanaka M, Ikeda M. Results of radiotherapy for inoperable locally advanced esophageal cancer. Int J Radiat Oncol Biol Phys 1989; 17(1): 49-54.
  12. Brenner B, Ilson DH, Minsky BD. Treatment of localized esophageal cancer. Semin Oncol 2004; 31(4): 554-65.
  13. Kavanagh B, Anscher M, Leopold K, Deutsch M, Gaydica E, Dodge R, et al. Patterns of failure following combined modality therapy for esophageal cancer, 1984-1990. Int J Radiat Oncol Biol Phys 1992; 24(4): 633-42.
  14. Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 1997; 337(3): 161-7.
  15. Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA, Jr., Al-Sarraf M, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 1999; 281(17): 1623-7.
  16. Gwynne S, Hurt C, Evans M, Holden C, Vout L, Crosby T. Definitive chemoradiation for oesophageal cancer--a standard of care in patients with non-metastatic oesophageal cancer. Clin Oncol (R Coll Radiol ) 2011; 23(3): 182-8.
  17. Semrau R, Herzog SL, Vallbohmer D, Kocher M, Holscher AH, Muller RP. Prognostic factors in definitive radiochemotherapy of advanced inoperable esophageal cancer. Dis Esophagus 2012; 25(6): 545-54.
  18. Motoori M, Yano M, Ishihara R, Yamamoto S, Kawaguchi Y, Tanaka K, et al. Comparison between radical esophagectomy and definitive chemoradiotherapy in patients with clinical T1bN0M0 esophageal cancer. Ann Surg Oncol 2012; 19(7): 2135-41.
  19. Ghadimi MR, Rasouli M, Mahmoodi M, Mohammad K. Prognostic factors for the survival of patients with esophageal cancer in Northern Iran. J Res Med Sci 2011; 16(10): 1261-72.
  20. Aghcheli K, Marjani HA, Nasrollahzadeh D, Islami F, Shakeri R, Sotoudeh M, et al. Prognostic factors for esophageal squamous cell carcinoma--a population-based study in Golestan Province, Iran, a high incidence area. PLoS One 2011; 6(7): e22152.
  21. Byun SJ, Kim JH, Kim OB, Song HS. Concurrent chemoradiotherapy in locally advanced esophageal cancer. Journal of the Korean Society for Therapeutic Radiology and Oncology 2011; 29(1): 20-7.
  22. Liu HC, Hung SK, Huang CJ, Chen CC, Chen MJ, Chang CC, et al. Esophagectomy for locally advanced esophageal cancer, followed by chemoradiotherapy and adjuvant chemotherapy. World J Gastroenterol 2005; 11(34): 5367-72.
Journal of Isfahan Medical School
Volume 32, Issue 291 - Serial Number 291
May and June 2014
Pages 982-990

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History

  • Receive Date: 07 November 2013
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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