Chemoradiation for oesophageal cancer: the choice of treatment modality
Abstract Background Locally advanced oesophageal cancer can be treated with definitive chemoradiation (dCRT) or with neoadjuvant chemoradiation followed by surgery (nCRT + S), but treatment modality choice is not always clear. The aim of this study was to investigate the factors associated with the...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-023-02290-9 |
| _version_ | 1797811314584715264 |
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| author | Pauliina M. Kitti Maria Faltinova Juha Kauppi Jari Räsänen Tiina Saarto Tiina Seppälä Anu M. Anttonen |
| author_facet | Pauliina M. Kitti Maria Faltinova Juha Kauppi Jari Räsänen Tiina Saarto Tiina Seppälä Anu M. Anttonen |
| author_sort | Pauliina M. Kitti |
| collection | DOAJ |
| description | Abstract Background Locally advanced oesophageal cancer can be treated with definitive chemoradiation (dCRT) or with neoadjuvant chemoradiation followed by surgery (nCRT + S), but treatment modality choice is not always clear. The aim of this study was to investigate the factors associated with the choice of treatment modality in locally advanced oesophageal cancer. Methods This was a retrospective cohort study of 149 patients treated with dCRT(n = 85) or nCRT + S (n = 64) for oesophageal cancer in Helsinki University Hospital in 2008–2018. Logistic regression was used to analyse factors associated with choice of treatment modality and to compare dosimetric factors with postoperative complications. Multivariate analyses identified factors associated with survival. Results Surgery was performed after chemoradiation as planned on 64/91 patients (70%). 28/64 had pathological complete response (44%). Probability of nCRT + S was higher in stages I-III versus IV (OR 3.62, 95% CI 1.53–8.53; P = .003), ECOG 0–1 versus 2 (OR 6.99, 95% CI 1.81–26.96; P = .005) or in the middle/lower vs upper oesophageal tumours (OR 5.61, 95% CI 1.83–17.16, P = .003). Probability for surgery was lower, if patient had lost > 10% of body weight (OR 0.46, 95% CI 0.21–0.98, P = 0.043). Patients in the nCRT + S group had significantly better median overall survival (mOS) and local control than the dCRT group (60 vs. 10 months, P < .001 and 53 vs. 6 months, P < 0.0001, respectively). 10/85 (12%) patients died within three months after dCRT. In multivariate analysis, nCRT + S was associated with improved mOS (HR 0.28, 95% CI 0.17–0.44, P < .001). Current smokers had worse mOS (HR 2.02, 95% CI 1.04–3.92, P = .037) compared to never-smokers. No significant dosimetric factor associated with postoperative complications was found. Conclusion The overall clinical status of the patients and the stage of the cancer guide the choice of treatment modalities, leading to overtreatment. Patients with better prognoses were more likely operated after chemoradiation, although there is no evidence of OS benefit in previous randomized trials. On the other hand, the prognosis was poor for patients with poor general health and advanced cancers, despite the chemoradiation. Thus, there are signs of overtreatment. MDT practice should be recommended to optimise the choice of treatment modalities. Smoking status is an independent factor associated with survival. |
| first_indexed | 2024-03-13T07:21:51Z |
| format | Article |
| id | doaj.art-14e1dcd6fa77423cb0ad0eb26597963e |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-03-13T07:21:51Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-14e1dcd6fa77423cb0ad0eb26597963e2023-06-04T11:35:19ZengBMCRadiation Oncology1748-717X2023-05-011811910.1186/s13014-023-02290-9Chemoradiation for oesophageal cancer: the choice of treatment modalityPauliina M. Kitti0Maria Faltinova1Juha Kauppi2Jari Räsänen3Tiina Saarto4Tiina Seppälä5Anu M. Anttonen6Department of Oncology, HUS Comprehensive Cancer Centre and University of HelsinkiDepartment of Oncology, HUS Comprehensive Cancer Centre and University of HelsinkiDepartment of General Thoracic and Esophageal Surgery, Helsinki University Hospital and University of HelsinkiDepartment of General Thoracic and Esophageal Surgery, Helsinki University Hospital and University of HelsinkiDepartment of Oncology, HUS Comprehensive Cancer Centre and University of HelsinkiDepartment of Oncology, HUS Comprehensive Cancer Centre and University of HelsinkiDepartment of Oncology, HUS Comprehensive Cancer Centre and University of HelsinkiAbstract Background Locally advanced oesophageal cancer can be treated with definitive chemoradiation (dCRT) or with neoadjuvant chemoradiation followed by surgery (nCRT + S), but treatment modality choice is not always clear. The aim of this study was to investigate the factors associated with the choice of treatment modality in locally advanced oesophageal cancer. Methods This was a retrospective cohort study of 149 patients treated with dCRT(n = 85) or nCRT + S (n = 64) for oesophageal cancer in Helsinki University Hospital in 2008–2018. Logistic regression was used to analyse factors associated with choice of treatment modality and to compare dosimetric factors with postoperative complications. Multivariate analyses identified factors associated with survival. Results Surgery was performed after chemoradiation as planned on 64/91 patients (70%). 28/64 had pathological complete response (44%). Probability of nCRT + S was higher in stages I-III versus IV (OR 3.62, 95% CI 1.53–8.53; P = .003), ECOG 0–1 versus 2 (OR 6.99, 95% CI 1.81–26.96; P = .005) or in the middle/lower vs upper oesophageal tumours (OR 5.61, 95% CI 1.83–17.16, P = .003). Probability for surgery was lower, if patient had lost > 10% of body weight (OR 0.46, 95% CI 0.21–0.98, P = 0.043). Patients in the nCRT + S group had significantly better median overall survival (mOS) and local control than the dCRT group (60 vs. 10 months, P < .001 and 53 vs. 6 months, P < 0.0001, respectively). 10/85 (12%) patients died within three months after dCRT. In multivariate analysis, nCRT + S was associated with improved mOS (HR 0.28, 95% CI 0.17–0.44, P < .001). Current smokers had worse mOS (HR 2.02, 95% CI 1.04–3.92, P = .037) compared to never-smokers. No significant dosimetric factor associated with postoperative complications was found. Conclusion The overall clinical status of the patients and the stage of the cancer guide the choice of treatment modalities, leading to overtreatment. Patients with better prognoses were more likely operated after chemoradiation, although there is no evidence of OS benefit in previous randomized trials. On the other hand, the prognosis was poor for patients with poor general health and advanced cancers, despite the chemoradiation. Thus, there are signs of overtreatment. MDT practice should be recommended to optimise the choice of treatment modalities. Smoking status is an independent factor associated with survival.https://doi.org/10.1186/s13014-023-02290-9Oesophageal cancerChemoradiotherapyNeoadjuvant therapySurgical oncologyRadiotherapyDosimetric parameters |
| spellingShingle | Pauliina M. Kitti Maria Faltinova Juha Kauppi Jari Räsänen Tiina Saarto Tiina Seppälä Anu M. Anttonen Chemoradiation for oesophageal cancer: the choice of treatment modality Radiation Oncology Oesophageal cancer Chemoradiotherapy Neoadjuvant therapy Surgical oncology Radiotherapy Dosimetric parameters |
| title | Chemoradiation for oesophageal cancer: the choice of treatment modality |
| title_full | Chemoradiation for oesophageal cancer: the choice of treatment modality |
| title_fullStr | Chemoradiation for oesophageal cancer: the choice of treatment modality |
| title_full_unstemmed | Chemoradiation for oesophageal cancer: the choice of treatment modality |
| title_short | Chemoradiation for oesophageal cancer: the choice of treatment modality |
| title_sort | chemoradiation for oesophageal cancer the choice of treatment modality |
| topic | Oesophageal cancer Chemoradiotherapy Neoadjuvant therapy Surgical oncology Radiotherapy Dosimetric parameters |
| url | https://doi.org/10.1186/s13014-023-02290-9 |
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