Annals of Surgical Oncology

, Volume 20, Issue 6, pp 1985–1992 | Cite as

Survival after Definitive (Chemo)Radiotherapy in Esophageal Cancer Patients: A Population-Based Study in the North-East Netherlands

  • Justin K. Smit
  • Christina T. Muijs
  • Johannes G. M. Burgerhof
  • Gabriel Paardekooper
  • Paul R. Timmer
  • Karin Muller
  • Dankert Woutersen
  • Véronique E. Mul
  • Jannet C. Beukema
  • Geke A. P. Hospers
  • Boukje A. C. van Dijk
  • Johannes A. Langendijk
  • John Th. M. Plukker
Gastrointestinal Oncology

Abstract

Background

Definitive (chemo)radiotherapy is employed in esophageal cancer patients as an alternative for patients considered medically unfit for surgery or having unresectable tumors. We evaluated a population-based cohort to improve the selection for intensified nonsurgical strategies and to identify prognostic factors.

Methods

Patients who had squamous cell carcinoma (SCC) or adenocarcinoma (AC) were treated in four referral centers in the north-east Netherlands with definitive chemoradiotherapy (dCRT) or radiotherapy (dRT) between 1996 and 2008.

Results

Of the 287 included patients, 110 were treated with dCRT and 177 with dRT. Median overall survival (OS) was 11 months (95 % confidence interval: 10–12 months), with OS of 22 and 8 % and disease-free survival (DFS) of 16 and 5 % at 2 and 5 years, respectively. DFS at 2 and 5 years was 24 and 9 % for SCC versus 10 and 2 % for AC patients (P = 0.006). OS after 2 and 5 years was 29 and 14 % for SCC patients versus 17 and 3 % for AC patients (P = 0.044). On multivariate Cox regression, SCC was an independent prognostic factor for DFS [P = 0.020, hazard ratio (HR) = 0.71] and OS (P = 0.047, HR = 0.76). On matched cohort analysis, DFS was higher in the dCRT group compared with dRT patients (P = 0.016). The locoregional failure rate was lower in the dCRT group and in SCC patients (P = 0.001 and 0.046).

Conclusions

Long-term results and the local control rate in SCC patients were better after definitive (chemo)radiotherapy compared with in AC patients. SCC was an independent prognostic factor for survival. Definitive chemoradiotherapy leads to improved local control rate and DFS.

Keywords

Overall Survival Squamous Cell Carcinoma Gross Tumor Volume Radiation Therapy Oncology Group Squamous Cell Carcinoma Patient 

Notes

Acknowledgment

Supported by GUIDE Post-graduate School of Medicine, University of Groningen. The authors would like to thank Michael G. Dickinson MD for editing our manuscript.

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Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Justin K. Smit
    • 1
  • Christina T. Muijs
    • 2
  • Johannes G. M. Burgerhof
    • 3
  • Gabriel Paardekooper
    • 4
  • Paul R. Timmer
    • 4
  • Karin Muller
    • 5
  • Dankert Woutersen
    • 6
  • Véronique E. Mul
    • 2
  • Jannet C. Beukema
    • 2
  • Geke A. P. Hospers
    • 7
  • Boukje A. C. van Dijk
    • 8
  • Johannes A. Langendijk
    • 2
  • John Th. M. Plukker
    • 1
  1. 1.Surgical Oncology of the University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  2. 2.Radiation Oncology of the University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  3. 3.Epidemiology of the University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  4. 4.Radiation OncologyIsala KliniekenZwolleThe Netherlands
  5. 5.Radiotherapy Institute Stedendriehoek en OmstrekenDeventerThe Netherlands
  6. 6.Medisch Spectrum TwenteEnschedeThe Netherlands
  7. 7.Medical Oncology of the University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  8. 8.Section of EpidemiologyComprehensive Cancer CentersUtrechtThe Netherlands

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