1. A national study to assess outcomes of definitive chemoradiation regimens in proximal esophageal cancer.
- Author
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de Vos-Geelen J, Hoebers FJP, Geurts SME, Hoeben A, de Greef BTA, Voncken FEM, Bogers JHA, Braam PM, Muijs CKT, de Jong MA, Kasperts N, Rozema T, Jeene PM, Blom GJ, van Dieren JM, Hulshof MCCM, van Laarhoven HWM, Grabsch HI, Lemmens VEPP, Tjan-Heijnen VCG, and Nieuwenhuijzen GAP
- Subjects
- Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols adverse effects, Carboplatin administration & dosage, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell pathology, Chemoradiotherapy adverse effects, Cisplatin administration & dosage, Esophageal Neoplasms mortality, Esophageal Neoplasms pathology, Female, Humans, Logistic Models, Male, Middle Aged, Netherlands, Paclitaxel administration & dosage, Propensity Score, Proportional Hazards Models, Radiotherapy Dosage, Retrospective Studies, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Squamous Cell therapy, Chemoradiotherapy methods, Esophageal Neoplasms therapy
- Abstract
Background: Proximal esophageal cancer (EC) is commonly treated with definitive chemoradiation (CRT). The radiation dose and type of chemotherapy backbone are still under debate. The objective of this study was to compare the treatment outcomes of contemporary CRT regimens. Material and Methods: In this retrospective observational cohort study, we included patients with locally advanced squamous cell cancer of the proximal esophagus, from 11 centers in the Netherlands, treated with definitive CRT between 2004 and 2014. Each center had a preferential CRT regimen, based on cisplatin (Cis) or carboplatin-paclitaxel (CP) combined with low (≤50.4 Gy) or high (>50.4 Gy) dose radiotherapy (RT). Differences in overall survival (OS) between CRT regimens were assessed using a fully adjusted Cox proportional hazards and propensity score (PS) weighted model. Safety profiles were compared using a multilevel logistic regression model. Results: Two hundred patients were included. Fifty-four, 39, 95, and 12 patients were treated with Cis-low-dose RT, Cis-high-dose RT, CP-low-dose RT, and CP-high-dose RT, respectively. Median follow-up was 62.6 months (95% CI: 47.9-77.2 months). Median OS (21.9 months; 95% CI: 16.9-27.0 months) was comparable between treatment groups (logrank p = .88), confirmed in the fully adjusted and PS weighted model ( p > .05). Grades 3-5 acute adverse events were less frequent in patients treated with CP-low-dose RT versus Cis-high-dose RT (OR 3.78; 95% CI: 1.31-10.87; p = .01). The occurrence of grades 3-5 late toxicities was not different between treatment groups. Conclusion: Our study was unable to demonstrate a difference in OS between the CRT regimens, probably related to the relatively small sample size. Based on the superior safety profile, carboplatin and paclitaxel-based CRT regimens are preferred in patients with locally advanced proximal EC.
- Published
- 2020
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