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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2013

01-06-2013 | Gastrointestinal Oncology

Survival after Definitive (Chemo)Radiotherapy in Esophageal Cancer Patients: A Population-Based Study in the North-East Netherlands

Authors: Justin K. Smit, MD, Christina T. Muijs, MD, Johannes G. M. Burgerhof, MSc, Gabriel Paardekooper, MD, Paul R. Timmer, MD, PhD, Karin Muller, MD, Dankert Woutersen, MD, Véronique E. Mul, MD, Jannet C. Beukema, MD, Geke A. P. Hospers, MD, PhD, Boukje A. C. van Dijk, PhD, Johannes A. Langendijk, MD, PhD, John Th. M. Plukker, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2013

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Abstract

Background

Definitive (chemo)radiotherapy is employed in esophageal cancer patients as an alternative for patients considered medically unfit for surgery or having unresectable tumors. We evaluated a population-based cohort to improve the selection for intensified nonsurgical strategies and to identify prognostic factors.

Methods

Patients who had squamous cell carcinoma (SCC) or adenocarcinoma (AC) were treated in four referral centers in the north-east Netherlands with definitive chemoradiotherapy (dCRT) or radiotherapy (dRT) between 1996 and 2008.

Results

Of the 287 included patients, 110 were treated with dCRT and 177 with dRT. Median overall survival (OS) was 11 months (95 % confidence interval: 10–12 months), with OS of 22 and 8 % and disease-free survival (DFS) of 16 and 5 % at 2 and 5 years, respectively. DFS at 2 and 5 years was 24 and 9 % for SCC versus 10 and 2 % for AC patients (P = 0.006). OS after 2 and 5 years was 29 and 14 % for SCC patients versus 17 and 3 % for AC patients (P = 0.044). On multivariate Cox regression, SCC was an independent prognostic factor for DFS [P = 0.020, hazard ratio (HR) = 0.71] and OS (P = 0.047, HR = 0.76). On matched cohort analysis, DFS was higher in the dCRT group compared with dRT patients (P = 0.016). The locoregional failure rate was lower in the dCRT group and in SCC patients (P = 0.001 and 0.046).

Conclusions

Long-term results and the local control rate in SCC patients were better after definitive (chemo)radiotherapy compared with in AC patients. SCC was an independent prognostic factor for survival. Definitive chemoradiotherapy leads to improved local control rate and DFS.
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Metadata
Title
Survival after Definitive (Chemo)Radiotherapy in Esophageal Cancer Patients: A Population-Based Study in the North-East Netherlands
Authors
Justin K. Smit, MD
Christina T. Muijs, MD
Johannes G. M. Burgerhof, MSc
Gabriel Paardekooper, MD
Paul R. Timmer, MD, PhD
Karin Muller, MD
Dankert Woutersen, MD
Véronique E. Mul, MD
Jannet C. Beukema, MD
Geke A. P. Hospers, MD, PhD
Boukje A. C. van Dijk, PhD
Johannes A. Langendijk, MD, PhD
John Th. M. Plukker, MD, PhD
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2824-2

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