title: Single centre outcomes from definitive chemo-radiotherapy and single modality radiotherapy for locally advanced oesophageal cancer.
abstract: BACKGROUND
  Definitive chemo-radiotherapy (dCRT) has been advocated as an alternative to surgical resection for the treatment of locally advanced oesophageal cancer (OC). We have retrospectively reviewed 4 years' experience of patients (pts) who underwent contemporary staging and were treated with concurrent chemo-radiotherapy (dCRT) or single modality radical radiotherapy (RT) with curative intent.
  
  
  METHODS
  Retrospective analysis permitted identification of consecutive patients who underwent contemporary staging prior to non-surgical treatment for locally advanced oesophageal carcinoma. The primary outcomes were overall survival (OS) and disease-free survival (DFS), adjusted for baseline differences in age, tumour staging and histological cell type. All patients were treated with either dCRT or single modality RT within a single centre between 2009 and 2012.
  
  
  RESULTS
  We identified 235 patients in total [median age 69.8 years, male =130 pts, female =105 pts, adenocarcinoma (ACA) =85 pts, squamous =150 pts]. A total of 190 pts received dCRT and 45 patients were treated with RT. All patients were staged with CT of chest, abdomen and pelvis, 226 patients underwent endoscopic ultrasound (EUS), and 183 patients had PET-CT. Patients treated with dCRT demonstrated longer OS (27 vs. 25 months respectively, P=0.02) and DFS (31 vs. 16 months respectively, P=0.01) compared to those treated with RT. More advanced tumour stage (stage 3 vs. stage 1/2) at presentation conferred poorer OS (32 vs. 38.2 months, P=0.02) and DFS (11 vs. 28 months, P=0.013). We demonstrated an acceptable toxicity profile with only 77 patients (32.8%) suffering grade 3 toxicity and 9 patients (4.2%) experiencing grade 4 toxicity by CTC criteria. The NG/PEG feeding rates were 4% across all treated patients.
  
  
  CONCLUSIONS
  This retrospective analysis is in keeping with current treatment paradigms emphasising the importance and safety of concurrent CRT in maximising curative potential for patients undergoing non-surgical treatment of OC. Although retrospective, in comparison to similar retrospective series from both our centre and historical literature, this data suggest improvements in OS and DFS, possibly due to improved patient selection through the use of more effective tumour staging.
authors.affiliation: 1 Beatson West of Scotland Cancer Centre, Glasgow, G12 0YN, UK ; 2 Department of Surgery, Royal Alexandra Hospital, Paisley, PA2 9PN, Renfrewshire, UK.
authors.forename: Ben Alexander
authors.initials: BA
authors.lastname: Fulton
authors.affiliation: 1 Beatson West of Scotland Cancer Centre, Glasgow, G12 0YN, UK ; 2 Department of Surgery, Royal Alexandra Hospital, Paisley, PA2 9PN, Renfrewshire, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Gray
authors.affiliation: 1 Beatson West of Scotland Cancer Centre, Glasgow, G12 0YN, UK ; 2 Department of Surgery, Royal Alexandra Hospital, Paisley, PA2 9PN, Renfrewshire, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: McDonald
authors.affiliation: 1 Beatson West of Scotland Cancer Centre, Glasgow, G12 0YN, UK ; 2 Department of Surgery, Royal Alexandra Hospital, Paisley, PA2 9PN, Renfrewshire, UK.
authors.forename: David
authors.initials: D
authors.lastname: McIntosh
authors.affiliation: 1 Beatson West of Scotland Cancer Centre, Glasgow, G12 0YN, UK ; 2 Department of Surgery, Royal Alexandra Hospital, Paisley, PA2 9PN, Renfrewshire, UK.
authors.forename: Vivienne
authors.initials: V
authors.lastname: MacLaren
authors.affiliation: 1 Beatson West of Scotland Cancer Centre, Glasgow, G12 0YN, UK ; 2 Department of Surgery, Royal Alexandra Hospital, Paisley, PA2 9PN, Renfrewshire, UK.
authors.forename: Aisling
authors.initials: A
authors.lastname: Hennessy
authors.affiliation: 1 Beatson West of Scotland Cancer Centre, Glasgow, G12 0YN, UK ; 2 Department of Surgery, Royal Alexandra Hospital, Paisley, PA2 9PN, Renfrewshire, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Grose
keywords: Chemo-radiotherapy (CRT); oesophageal cancer (OC)