Clinical prognostic factors for locally advanced esophageal squamous carcinoma treated after definitive chemoradiotherapy.
OBJECTIVE
Locally advanced esophageal cancers are generally treated with neoadjuvant chemoradiotherapy, followed by surgery in operable candidates. However, even if the patients were diagnosed as operable disease, surgery could not be performed on patients with poor condition or other comorbidity. In this case, definitive chemoradiotherapy (dCRT) is the other option for localized esophageal cancer. Therefore, the purpose of this study was to evaluate the efficacy and clinical prognostic factors for dCRT in locally advanced esophageal cancer.


METHODS
We conducted a review of patients who received dCRT for locally advanced squamous esophageal cancer from 2004 to 2010, focusing on stages III and IVa. All patients received at least two cycles of platinum-based chemotherapy during radiation, and all tumor burdens were included in the radiation field. The treatment results were analyzed for patterns of failure and prognostic factors associated with survival.


RESULTS
In total, 63 patients were enrolled in this study. The overall response rate was 84.1%. Relief from dysphagia after dCRT was achieved in 48 patients. The most frequent failure was local recurrence. The median overall survival (OS) was 23.0 months, and the 2-year survival rate was 45.4%. Similar results were observed for elderly study patients. Significant prognostic factors for OS were duration of smoking, high grade of dysphagia (score of 3 or 4), and shorter duration of progression-free and dysphagia-free survival. Maintenance chemotherapy after dCRT did not influence OS. However, "good risk" patients receiving maintenance chemotherapy showed better OS than those who did not receive maintenance chemotherapy (30.4 months vs. 12.0 months, p=0.002).


CONCLUSIONS
dCRT has a major role in improving survival and palliation of dysphagia in inoperable advanced esophageal cancer, even in elderly patients. Maintenance chemotherapy after dCRT may be effective in prolonging survival in "good risk" patients.
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Dae-Eun
DE
Kim
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Uh-Jin
UJ
Kim
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Won-Young
WY
Choi
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Mi-Young
MY
Kim
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Seung-Hun
SH
Kim
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Min-Jee
MJ
Kim
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Hyun-Jeong
HJ
Shim
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Jun-Eul
JE
Hwang
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Woo-Kyun
WK
Bae
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Ik-Joo
IJ
Chung
Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea.
Taek-Keun
TK
Nam
Department of Chest Surgery, Chonnam National University Medical School, Gwangju, Korea.
Kook-Joo
KJ
Na
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Sang-Hee
SH
Cho
Chemoradiotherapy; Esophageal squamous cell carcinoma; Prognosis