title: Definitive chemoradiation for oesophageal cancer--a standard of care in patients with non-metastatic oesophageal cancer.
abstract: OBJECTIVE
  A retrospective analysis was carried out of 291 cases of oesophageal cancer treated with definitive chemoradiotherapy (dCRT) at a single UK cancer centre between 1995 and 2009. Our protocol consisted of two cycles of neoadjuvant platinum-based chemotherapy followed by two further cycles given concurrently with 50Gy of external beam radiotherapy delivered in 25 fractions over 5 weeks.
  
  
  METHODS
  Demographic, patient and outcome data were recorded prospectively through an electronic health record and retrospectively analysed, using appropriate statistical tools.
  
  
  RESULTS
  Data on 266 patients were available for analysis. The median age was 66.6 years, 53% were adenocarcinomas. dCRT was used instead of surgery because of age/co-morbidity in 44% and disease extent in 39%. Ninety-three per cent of patients completed treatment according to protocol. Grade 3 and 4 toxicities were seen in 42 and 7%, respectively. Median survival was 20.6 months; 2, 3 and 5 year survival rates were 43.6, 32.9 and 19.5%, respectively. Advanced disease was associated with a worse outcome. Shorter disease length was associated with a better median survival, but some patients with disease >10cm had long-term disease control. The effect of other patient- and disease-related factors was also analysed.
  
  
  CONCLUSIONS
  We present data showing that dCRT is well tolerated and should be considered as an alternative to surgery for all patients with locally advanced oesophageal cancer, not only those with co-morbidity. Furthermore, the benefits of dCRT are not confined to carcinomas with squamous histology.
authors.affiliation: Department of Clinical Oncology, Velindre Cancer Centre, Velindre Place, Cardiff, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gwynne
authors.forename: C
authors.initials: C
authors.lastname: Hurt
authors.forename: M
authors.initials: M
authors.lastname: Evans
authors.forename: C
authors.initials: C
authors.lastname: Holden
authors.forename: L
authors.initials: L
authors.lastname: Vout
authors.forename: T
authors.initials: T
authors.lastname: Crosby
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011878:Radiotherapy; D012189:Retrospective Studies; D059039:Standard of Care; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents