Mickey S Ising1,2, Katy Marino2, Jaimin R Trivedi2, Adam A Rojan3, Neal E Dunlap4, Victor van Berkel2, Matthew P Fox5. 1. Department of Surgery, University of Louisville School of Medicine, 201 Abraham Flexner Way, Ste 1200, Louisville, KY, 40202, USA. 2. Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA. 3. Division of Medical Oncology and Hematology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA. 4. Department of Radiation Oncology, Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA. 5. Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA. Matthew.Fox@ulp.org.
Abstract
BACKGROUND: Neoadjuvant chemoradiotherapy followed by resection is standard of care for patients with locally advanced esophageal cancer, however, a significant portion of these patients do not undergo surgical intervention. This study evaluates radiation dose and other factors associated with undergoing esophageal resection and their impact on outcomes including survival. METHODS: Patients diagnosed with esophageal cancer between 2010 and 15 were queried from the National Cancer Database and stratified into low-dose radiation (41.4 Gy) (LDR) or high-dose radiation (50.0 or 50.4 Gy) (HDR) groups. Multivariable Logistic and Cox Regression analyses were performed to investigate the effect of multiple variables on the likelihood of undergoing esophagectomy and overall survival, respectively. Propensity score matching was performed to reduce bias between groups. RESULTS: A total of 3633 patients met study criteria with 3005 (82.7%) undergoing esophagectomy. A greater proportion received HDR (3163 (87.1%)) than LDR (470 (12.9%)). The use of LDR increased from 4.7% (n = 22) in 2010 to 20.7% (n = 154) in 2015. Factors associated with undergoing esophagectomy included LDR, adenocarcinoma histology, and younger age. Radiation dosage did not impact overall survival, but undergoing esophagectomy was associated with improved survival. After propensity matching, a greater portion of the LDR group underwent esophagectomy (87.0 vs 81.1%, p = 0.013). There was no difference in R0 3 resection (93.2 vs 92.4%, p = 0.678) or complete pathologic response (19.3 vs 21.5%, p = 0.442) between LDR and HDR groups. CONCLUSION: The use of LDR is increasing but still underutilized. LDR is associated with increased rates of esophagectomy without negatively impacting overall survival, R0 resection, or complete pathologic response.
BACKGROUND: Neoadjuvant chemoradiotherapy followed by resection is standard of care for patients with locally advanced esophageal cancer, however, a significant portion of these patients do not undergo surgical intervention. This study evaluates radiation dose and other factors associated with undergoing esophageal resection and their impact on outcomes including survival. METHODS:Patients diagnosed with esophageal cancer between 2010 and 15 were queried from the National Cancer Database and stratified into low-dose radiation (41.4 Gy) (LDR) or high-dose radiation (50.0 or 50.4 Gy) (HDR) groups. Multivariable Logistic and Cox Regression analyses were performed to investigate the effect of multiple variables on the likelihood of undergoing esophagectomy and overall survival, respectively. Propensity score matching was performed to reduce bias between groups. RESULTS: A total of 3633 patients met study criteria with 3005 (82.7%) undergoing esophagectomy. A greater proportion received HDR (3163 (87.1%)) than LDR (470 (12.9%)). The use of LDR increased from 4.7% (n = 22) in 2010 to 20.7% (n = 154) in 2015. Factors associated with undergoing esophagectomy included LDR, adenocarcinoma histology, and younger age. Radiation dosage did not impact overall survival, but undergoing esophagectomy was associated with improved survival. After propensity matching, a greater portion of the LDR group underwent esophagectomy (87.0 vs 81.1%, p = 0.013). There was no difference in R0 3 resection (93.2 vs 92.4%, p = 0.678) or complete pathologic response (19.3 vs 21.5%, p = 0.442) between LDR and HDR groups. CONCLUSION: The use of LDR is increasing but still underutilized. LDR is associated with increased rates of esophagectomy without negatively impacting overall survival, R0 resection, or complete pathologic response.
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Authors: Nikhil I Khushalani; Cynthia Gail Leichman; Gary Proulx; Hector Nava; Lisa Bodnar; Donald Klippenstein; Alan Litwin; Judy Smith; Enriqueta Nava; Lakshmi Pendyala; Patrick Smith; William Greco; Joanne Berdzik; Harold Douglass; Lawrence Leichman Journal: J Clin Oncol Date: 2002-06-15 Impact factor: 44.544