Chia-Chin Li1, Chih-Yi Chen2,3, Ying-Hsiang Chou4,5, Chih-Jen Huang6, Hsiu-Ying Ku7,8, Chun-Ru Chien9,10,11. 1. Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan. 2. Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan. 3. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. 4. Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan. 5. Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan. 6. Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. 7. National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan. 8. Department of Healthcare Administration, Asia University, Taichung, Taiwan. 9. Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan. d16181@gmail.com. 10. Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan. d16181@gmail.com. 11. School of Medicine, College of Medicine, China Medical University, No. 91 Hsueh-Shih Road, North District, Taichung, 40402, Taiwan. d16181@gmail.com.
Abstract
BACKGROUND: The role of radiotherapy for cT4bNanyM0 esophageal squamous cell carcinoma (ESqCC) is relatively unclear, with both chemotherapy (C/T) alone and definitive concurrent chemoradiotherapy (dCCRT) being treatment options in the current guidelines. We aimed to compare the survival of dCCRT versus C/T for these patients via a population-based approach. METHODS: Eligible cT4b ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance the observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between dCCRT and C/T. We also evaluated OS in subgroups of either low or standard radiotherapy doses. RESULTS: Our primary analysis consisted of 247 patients in whom covariates were well balanced after PS weighing. The HR for death when dCCRT was compared with C/T was 0.36 (95% confidence interval 0.24-0.53, P < 0.001). Similar results were found for IECM. Statistical significance was only observed in the standard RT dose but not in the low dose in subgroup analyses. CONCLUSIONS: In this population-based nonrandomized study of cT4bNanyM0 ESqCC patients from Asia (Taiwan), we found that the use of radiotherapy with chemotherapy was associated with better overall survival than chemotherapy alone. Further studies (especially RCTs) are needed to confirm our findings.
BACKGROUND: The role of radiotherapy for cT4bNanyM0 esophageal squamous cell carcinoma (ESqCC) is relatively unclear, with both chemotherapy (C/T) alone and definitive concurrent chemoradiotherapy (dCCRT) being treatment options in the current guidelines. We aimed to compare the survival of dCCRT versus C/T for these patients via a population-based approach. METHODS: Eligible cT4b ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance the observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancermortality (IECM) were compared between dCCRT and C/T. We also evaluated OS in subgroups of either low or standard radiotherapy doses. RESULTS: Our primary analysis consisted of 247 patients in whom covariates were well balanced after PS weighing. The HR for death when dCCRT was compared with C/T was 0.36 (95% confidence interval 0.24-0.53, P < 0.001). Similar results were found for IECM. Statistical significance was only observed in the standard RT dose but not in the low dose in subgroup analyses. CONCLUSIONS: In this population-based nonrandomized study of cT4bNanyM0 ESqCC patients from Asia (Taiwan), we found that the use of radiotherapy with chemotherapy was associated with better overall survival than chemotherapy alone. Further studies (especially RCTs) are needed to confirm our findings.