A national study to assess outcomes of definitive chemoradiation regimens in proximal esophageal cancer
de Vos-Geelen, Judith; Hoebers, Frank J.P.; Geurts, Sandra M.E.; Hoeben, Ann; de Greef, Bianca T.A.; Voncken, Francine E.M.; Bogers, J. (Hans) A.; Braam, Pètra M.; Muijs, C. (Kristel) T.; de Jong, Martin A.; Kasperts, Nicolien; Rozema, Tom; Jeene, Paul M.; Blom, Gerrit J.; van Dieren, Jolanda M.; Hulshof, Maarten C.C.M.; van Laarhoven, Hanneke W.M.; Grabsch, Heike I.; Lemmens, Valery E.P.P.; Tjan-Heijnen, Vivianne C.G.; Nieuwenhuijzen, Grard A.P.
(2020) Acta Oncologica, volume 59, issue 8, pp. 895 - 903
(Article)
Abstract
Background: Proximal esophageal cancer (EC) is commonly treated with definitive chemoradiation (CRT). The radiation dose and type of chemotherapy backbone are still under debate. The objective of this study was to compare the treatment outcomes of contemporary CRT regimens. Material and Methods: In this retrospective observational cohort study, we included
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patients with locally advanced squamous cell cancer of the proximal esophagus, from 11 centers in the Netherlands, treated with definitive CRT between 2004 and 2014. Each center had a preferential CRT regimen, based on cisplatin (Cis) or carboplatin-paclitaxel (CP) combined with low (≤50.4 Gy) or high (>50.4 Gy) dose radiotherapy (RT). Differences in overall survival (OS) between CRT regimens were assessed using a fully adjusted Cox proportional hazards and propensity score (PS) weighted model. Safety profiles were compared using a multilevel logistic regression model. Results: Two hundred patients were included. Fifty-four, 39, 95, and 12 patients were treated with Cis-low-dose RT, Cis-high-dose RT, CP-low-dose RT, and CP-high-dose RT, respectively. Median follow-up was 62.6 months (95% CI: 47.9–77.2 months). Median OS (21.9 months; 95% CI: 16.9–27.0 months) was comparable between treatment groups (logrank p =.88), confirmed in the fully adjusted and PS weighted model (p >.05). Grades 3–5 acute adverse events were less frequent in patients treated with CP-low-dose RT versus Cis-high-dose RT (OR 3.78; 95% CI: 1.31–10.87; p =.01). The occurrence of grades 3–5 late toxicities was not different between treatment groups. Conclusion: Our study was unable to demonstrate a difference in OS between the CRT regimens, probably related to the relatively small sample size. Based on the superior safety profile, carboplatin and paclitaxel-based CRT regimens are preferred in patients with locally advanced proximal EC.
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Keywords: Hematology, Oncology, Radiology Nuclear Medicine and imaging, Journal Article
ISSN: 0284-186X
Publisher: Informa Healthcare
Note: Funding Information: HWML has served as a consultant for BMS, Celgene, Lilly, Nordic, and Servier and has received unrestricted research funding from Bayer, BMS, Celgene, Lilly, Merck Serono, MSD, Nordic, Philips, Roche, and Servier, all outside the submitted work. Funding Information: GAPN has received honoraria/travel grants from Medtronic, outside the submitted work. Funding Information: CTM has received institutional research funding from IBA RaySearch, Siemens, Elekta and Mirada, all outside the submitted work. Funding Information: VCGT-H has received honoraria/travel grants from Roche, Novartis, Pfizer, Lilly, and Accord Healthcare, and has received institutional research funding from AstraZeneca, Roche, Pfizer, Novartis, Eisai, and Lilly, all outside the submitted work. Funding Information: VEPPL has received an unrestricted research grant and educational grant from Roche, outside the submitted work. Publisher Copyright: © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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