Journal article
The Role of Definitive Radiation and Surgery in Metastatic Esophageal Cancer: An NCDB Investigation
The Annals of thoracic surgery, Vol.112(2), pp.459-466
08/01/2021
DOI: 10.1016/j.athoracsur.2020.08.034
PMID: 33096068
Abstract
Background. Approximately 40% of patients with esophageal cancer present with metastatic disease. Survival with palliative treatment is poor, and the benefit of aggressive focal therapies is unclear. This study aimed to identify a subset of patients with metastatic esophageal cancer with favorable outcomes after curative doses of radiation therapy, esophagectomy, or both.
Methods. Between 2004 and 2015, the study investigators found 28,101 patients with metastatic esophageal cancer in the National Cancer Database and identified those who underwent chemotherapy and definitive radiation therapy with or without surgery over the study period. The study compared the estimated median overall survival (OS) of all patients with metastatic esophageal cancer with the estimated median OS of patients with metastatic esophageal cancer who underwent radiation therapy with or without surgery. Multivariable analysis was used to examine clinical and pathologic factors associated with OS.
Results. At a median follow-up of 11.1 months, 3219 patients with a median age of 64 years and a radiation dose of 50.4 Gy were identified. Only 202 (6.2%) pa-tients undergoing definitive-dose radiation therapy underwent esophagectomy, with a median age of 60 years. The median OS durations for all patients, for patients treated with radiation, and for patients treated with radiation therapy in combination with esoph-agectomy were 6.6, 11.5, and 30.2 months, respectively. Among patients undergoing surgery, median OS after surgery was 23.7 months. Patients with lung, liver, or bone metastases were less likely to undergo esoph-agectomy. On multivariable analysis, esophagectomy and low tumor grade were associated with higher OS, whereas liver and bone metastases at diagnosis were associated with worse OS.
Conclusions. This analysis suggests that select subsets of patients with primarily nonvisceral, nonosseous met-astatic esophageal cancer have favorable survival and may potentially benefit from aggressive local therapies. (C) 2021 by The Society of Thoracic Surgeons
Details
- Title: Subtitle
- The Role of Definitive Radiation and Surgery in Metastatic Esophageal Cancer: An NCDB Investigation
- Creators
- Steven N. Seyedin - University of IowaKalpaj R. Parekh - University of Iowa Hospitals and ClinicsTimothy Ginader - University of Iowa Hospitals and ClinicsJoseph M. Caster - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- The Annals of thoracic surgery, Vol.112(2), pp.459-466
- Publisher
- Elsevier
- DOI
- 10.1016/j.athoracsur.2020.08.034
- PMID
- 33096068
- ISSN
- 0003-4975
- eISSN
- 1552-6259
- Number of pages
- 8
- Grant note
- Department of Radiation Oncology, University of Iowa Hospital and Clinics
- Language
- English
- Date published
- 08/01/2021
- Academic Unit
- Anatomy and Cell Biology; Radiation Oncology; Cardiothoracic Surgery
- Record Identifier
- 9984284456502771
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