Tumor volume as outcome determinant in patients treated with chemoradiation for locally advanced esophageal cancer.
OBJECTIVE
The currently used tumor-node metastasis (TNM) staging method is generally not applicable to patients with unresectable esophageal carcinomas. There is a need for both an efficient, easy-to-perform clinical classification and for identification of pretherapeutic prognostic factors that would be useful for oncologists, one of which is tumor volume.


METHODS
Records of 148 patients, admitted to hospital during the period January 1993 to December 2001, were evaluated retrospectively. Median age was 65.7 years (range, 35.5-85.5 years). Most patients had SCC (84.5%). Using the computed tomography (CT) scan classification, tumors were recorded as follows: 1 T1, 42 T2, 93 T3, 6 T4, 2 Nx, 72 N0, 74 N1. Tumor volume from the CT scans was determined as the sum of 2 opposed truncated cones. Median tumor volume was 57.5 cm3 (range, 0.6-288 cm3).


RESULTS
Median follow-up was 15.1 month (range, 0.3-82.8 months). Survival rates at 1, 2, and 3 years were 42.5%, 21.6%, and 8%, respectively. Prognostic factors identified by univariate analysis were: dysphagia grade > or =2, other histology than squamous cell, tumor location below the carina, age <65 years and tumor volume > or =100 cm3. Prognostic factors identified with multivariate analysis were: dysphagia grade > or =2 (P = 0.013), weight loss > or =10% (P = 0.047), tumor location below the carina (P = 0.002), and tumor volume > or =100 cm3 (P = 0.041).


CONCLUSIONS
For patients that the TNM staging system is not applicable, tumor volume is a new powerful determinant of survival. Further clinical trials need to be carried out to validate this prospectively.
Créhange
Gilles
G
Department of Radiation Oncology, Besançon University Hospital, France. gilles.crehange@wanadoo.fr
Bosset
Mathieu
M
Lorchel
Fabrice
F
Fabrice
Lorchel
L
Buffet-Miny
Joëlle
J
Dumas
Jean Luc
JL
Mercier
Mariette
M
Puyraveau
Marc
M
Maingon
Philippe
P
Bosset
Jean François
JF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome