Treatment strategies for oesophageal cancer - time-trends and long term outcome data from a large tertiary referral centre
Open Access
- 15 April 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in Radiation Oncology
- Vol. 7 (1), 60
- https://doi.org/10.1186/1748-717X-7-60
Abstract
Treatment options for oesophageal cancer have changed considerably over the last decades with the introduction of multimodal treatment concepts dominating the progress in the field. However, it remains unclear in how far the documented scientific progress influenced and changed the daily routine practice. Since most patients with oesophageal cancer generally suffer from reduced overall health conditions it is uncertain how high the proportion of aggressive treatments is and whether outcomes are improved substantially. In order to gain insight into this we performed a retrospective analysis of patients treated at a larger tertiary referral centre over time course of 25 years. Data of all patients diagnosed with squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the oesophagus, treated between 1983 and 2007 in the department of radiation oncology of the LMU, were obtained. The primary endpoint of the data collection was overall survival (calculated from the date of diagnosis until death or last follow up). Changes in basic clinical characteristics, treatment approach and the effect on survival were analysed after dividing the cohort into five subsequent time periods (I-V) with 5 years each. In a second analysis any pattern of change regarding the use of radio(chemo)therapy (R(C)T) with and without surgery was determined. In total, 503 patients with SCC (78.5%) and AC (18.9%) of the oesophagus were identified. The average age was 60 years (range 35-91 years). 56.5% of the patients were diagnose with advanced UICC stages III-IV. R(C)T was applied to 353 (70.2%) patients; R(C)T+ surgery was performed in 134 (26.6%) patients, 63.8% of all received chemotherapy (platinum-based 5.8%, 5-fluorouracil (5-FU)12.1%, 42.3% 5-FU and mitomycin C (MMC)). The median follow-up period was 4.3 years. The median overall survival was 21.4 months. Over the time, patients were older, the formal tumour stage was more advanced, the incidence of AC was higher and the intensified treatment had a higher prevalence. However there was only a trend for an improved OS over the years with no difference between RCT with or without surgery (p = 0.09). The use of radiation doses over 54 Gy and the addition of chemotherapy (p = 0.002) were associated with improved OS. Although more complex treatment protocols were introduced into clinical routine, only a minor progress in OS rates was detectable. Main predictors of outcome in this cohort was the addition of chemotherapy. The addition of surgery to radio-chemotherapy may only be of value for very limited patient groups.Keywords
This publication has 53 references indexed in Scilit:
- Curative treatment of oesophageal carcinoma: current options and future developmentsRadiation Oncology, 2011
- The value of metabolic imaging to predict tumour response after chemoradiation in locally advanced rectal cancerRadiation Oncology, 2010
- Radiosensitization and growth inhibition of cancer cells mediated by an scFv antibody gene against DNA-PKcs in vitro and in vivoRadiation Oncology, 2010
- Four-dimensional dosimetry validation and study in lung radiotherapy using deformable image registration and Monte Carlo techniquesRadiation Oncology, 2010
- Lack of Cetuximab induced skin toxicity in a previously irradiated field: case report and review of the literatureRadiation Oncology, 2010
- Analysis of clinical and dosimetric factors associated with severe acute radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with concurrent chemotherapy and intensity-modulated radiotherapyRadiation Oncology, 2010
- Prescreening based on the presence of CT-scan abnormalities and biomarkers (KL-6 and SP-D) may reduce severe radiation pneumonitis after stereotactic radiotherapyRadiation Oncology, 2010
- Late treatment with imatinib mesylate ameliorates radiation-induced lung fibrosis in a mouse modelRadiation Oncology, 2009
- AT-101, a small molecule inhibitor of anti-apoptotic Bcl-2 family members, activates the SAPK/JNK pathway and enhances radiation-induced apoptosisRadiation Oncology, 2009
- Staging investigations for oesophageal cancer: a meta-analysisBritish Journal of Cancer, 2008