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Utilization and Outcomes of Radiation in Stage IV Esophageal Cancer

Open AccessPublished:November 06, 2022DOI:https://doi.org/10.1016/j.jtocrr.2022.100429
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      Abstract

      Introduction

      For patients with stage IV esophageal cancer, esophageal radiation may be used selectively for local control and palliation. We aimed to understand patterns of radiation administration among patients with stage IV esophageal cancer and any potential survival associations.

      Patients and Methods

      In this retrospective cohort study, the National Cancer Database was queried for patients with metastatic stage IV esophageal cancer diagnosed between 2016 and 2019. Patterns of radiation usage were identified. Survival was determined through Kaplan-Meier analysis of propensity score-matched pairs of patients that did and did not receive radiotherapy and time-to-event models.

      Results

      Overall, 12,088 stage IV esophageal cancer patients were identified, including 32.7% that received esophageal radiation. The median age was 65 (IQR: 58-73), and 82.6% were male. Among irradiated patients, the median total radiation dose was 35 Gy (IQR: 30-50 Gy) administered in a median of 14 fractions (IQR: 10-25) given over 22 days (IQR: 14-39). Overall, esophageal radiation was not associated with better survival (log-rank p = 0.41). When stratified by radiation dose, a survival advantage (over no radiation) was seen in the 1,144 patients (29% of irradiated patients) who received 45-59.9 Gy (TR [time ratio]: 1.28; 95% CI: 1.20-1.37; p < 0.001) and the 88 patients (2.2%) who received 60-80 Gy (TR: 1.37; 95% CI: 1.11-1.69; p = 0.003).

      Conclusion

      One-third of metastatic stage IV esophageal cancer patients in the NCDB received esophageal radiation. The majority received a radiation dose that, while consistent with palliative regimens, was not associated with a survival advantage. Further study is warranted to understand the indications for radiation in stage IV esophageal cancer and potentially re-evaluate the most appropriate radiation dose for palliation.

      Keywords

      Abbreviations:

      CoC (Commission on Cancer), NCDB (National Cancer Database), NCCN (National Comprehensive Cancer Network), STROBE (Strengthening the Reporting of Observational Studies in Epidemiology), Stage IV-Nodal (Patients with stage IV esophageal cancer whose metastatic extent is limited to nonregional lymph nodes only), Stage IV-Single Organ (Patients with stage IV esophageal cancer whose metastatic extent is limited to a single organ only), Stage IV-Multi-Organ (Patients with stage IV esophageal cancer whose metastatic extent involves multiple organs)