title: Palliative Radiotherapy in the Presence of Well-Controlled Metastatic Disease after Initial Chemotherapy May Prolong Survival in Patients with Metastatic Esophageal and Gastric Cancer.
abstract: OBJECTIVE
  We report the outcomes of patients treated with palliative radiotherapy (pRT) to the primary tumour in the context of well-controlled metastatic disease after initial chemotherapy.
  
  
  METHODS
  Clinical records of 132 patients with metastatic esophago-gastric (OG) cancer treated with palliative chemotherapy (pCT) between January 2009 and June 2013 were reviewed. Ninetyseven patients had responding or stable disease after 3 months of chemotherapy, of whom 53 patients received pRT to the primary tumour after initial chemotherapy in the presence of well-controlled metastatic disease (group A, pCT-RT). The remaining 44 patients were treated with pCT alone (group B, pCT). Treatment-related outcomes were assessed in above groups including time to local progression (TTLP), progression-free and overall survival.
  
  
  RESULTS
  The median overall survival for patients treated with pRT after initial chemotherapy (group A) was 23.3 months (95% confidence interval [CI], 17.70 to 28.89 months) and significantly higher than the 14 months (95% CI, 10.91 to 17.08 months) in patients treated with pCT alone (group B) (p < 0.001). The use of pCT-RT was an independent predictor of OS in multivariate analysis. Local recurrence was observed in 12/53 of patients (23%) in group A compared to 16/44 (36%) in group B. The median TTLP was significantly higher in patients after pCT-RT at 17.3 months (5.23 months to 44.50 months) compared to 8.3 months (range, 4.10 to 25.23 months) in patients treated with pCT alone (p=0.006).
  
  
  CONCLUSIONS
  The possibility of pRT influencing systemic disease in advanced OG cancer has not been reported, and results from the present study present strong arguments for investigation of this therapeutic strategy in a randomized trial.
authors: Department of Clinical Oncology, Castle Hill Hospital, Hull and East Yorkshire, NHS Trust, Hull, UK.
authors: Mohan
authors: M
authors: Hingorani
authors: Department of Clinical Oncology, Castle Hill Hospital, Hull and East Yorkshire, NHS Trust, Hull, UK.
authors: Sanjay
authors: S
authors: Dixit
authors: Hull and York Medical School, Hull, UK.
authors: Miriam
authors: M
authors: Johnson
authors: Department of Clinical Oncology, St. James Institute of Oncology, Leeds Teaching Hospital, NHS Trust, Leeds, UK.
authors: Victoria
authors: V
authors: Plested
authors: Department of Clinical Oncology, Castle Hill Hospital, Hull and East Yorkshire, NHS Trust, Hull, UK.
authors: Kevin
authors: K
authors: Alty
authors: Department of Clinical Oncology, Castle Hill Hospital, Hull and East Yorkshire, NHS Trust, Hull, UK.
authors: Peter
authors: P
authors: Colley
authors: Department of Clinical Oncology, Castle Hill Hospital, Hull and East Yorkshire, NHS Trust, Hull, UK.|Faculty of Science and Engineering, University of Hull, Hull, UK.|Faculty of Health and Well-Being, University of Sheffield-Hallam, Sheffield, UK.
authors: Andrew W
authors: AW
authors: Beavis
authors: Department of Clinical Oncology, Castle Hill Hospital, Hull and East Yorkshire, NHS Trust, Hull, UK.
authors: Rajarshi
authors: R
authors: Roy
authors: Department of Clinical Oncology, Castle Hill Hospital, Hull and East Yorkshire, NHS Trust, Hull, UK.
authors: Anthony
authors: A
authors: Maraveyas
mesh_terms: D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D016896:Treatment Outcome
keywords: Chemotherapy; Esophageal neoplasms; Palliative treatment; Radiotherapy; Stomach neoplasms