Cancer Res Treat.  2013 Dec;45(4):276-284.

Clinical Prognostic Factors for Locally Advanced Esophageal Squamous Carcinoma Treated after Definitive Chemoradiotherapy

• Kim DE
• Kim UJ
• Choi WY
• Kim MY
• Kim SH
• Kim MJ
• Shim HJ
• Hwang JE
• Bae WK
• Chung IJ
• Nam TK
• Na KJ
• Cho SH

Abstract

PURPOSE
Locally advanced esophageal cancers are generally treated with neoadjuvant chemoradiotherapy, followed by surgery in operable candidates. However, even if the patients were diagnosed as operable disease, surgery could not be performed on patients with poor condition or other comorbidity. In this case, definitive chemoradiotherapy (dCRT) is the other option for localized esophageal cancer. Therefore, the purpose of this study was to evaluate the efficacy and clinical prognostic factors for dCRT in locally advanced esophageal cancer.
MATERIALS AND METHODS
We conducted a review of patients who received dCRT for locally advanced squamous esophageal cancer from 2004 to 2010, focusing on stages III and IVa. All patients received at least two cycles of platinum-based chemotherapy during radiation, and all tumor burdens were included in the radiation field. The treatment results were analyzed for patterns of failure and prognostic factors associated with survival.
RESULTS
In total, 63 patients were enrolled in this study. The overall response rate was 84.1%. Relief from dysphagia after dCRT was achieved in 48 patients. The most frequent failure was local recurrence. The median overall survival (OS) was 23.0 months, and the 2-year survival rate was 45.4%. Similar results were observed for elderly study patients. Significant prognostic factors for OS were duration of smoking, high grade of dysphagia (score of 3 or 4), and shorter duration of progression-free and dysphagia-free survival. Maintenance chemotherapy after dCRT did not influence OS. However, "good risk" patients receiving maintenance chemotherapy showed better OS than those who did not receive maintenance chemotherapy (30.4 months vs. 12.0 months, p=0.002).
CONCLUSION
dCRT has a major role in improving survival and palliation of dysphagia in inoperable advanced esophageal cancer, even in elderly patients. Maintenance chemotherapy after dCRT may be effective in prolonging survival in "good risk" patients.

Keyword

Esophageal squamous cell carcinoma; Chemoradiotherapy; Prognosis

MeSH Terms

Aged
Carcinoma, Squamous Cell*
Chemoradiotherapy*
Comorbidity
Deglutition Disorders
Drug Therapy
Esophageal Neoplasms
Humans
Maintenance Chemotherapy
Prognosis
Recurrence
Smoke
Smoking
Survival Rate
Tumor Burden
Smoke

Figure

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  Fig. 1 Patient stratification.

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  Fig. 2 Kaplan-Meier estimation of overall survival and progression free survival in esophageal cancer treated with definitive chemoradiotherapy (n=63). Median overall survival was 23.0 months and median progression free survival was 10.9 months.

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  Fig. 3 Overall survival in various risk groups.

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