Experience in Locally Advanced Esophageal Cancer with Definitive Chemoradiotherapy at the National Oncology Institute in the Period 2012-2022

Abstract

<i>Introduction: </i>The World Health Organization (WHO) estimates 18 million people were diagnosed with cancers in 2020, of these 600,000 were esophageal cancer and ranks 6th in mortality. In Panama, in 2020, 58 new cases were diagnosed, with a lethality of 90%. Despite advances in the therapeutic approach and survival of localized esophageal cancer, we are unaware of the survival results associated with concomitant chemoradiotherapy treatment. <i>Methodology: </i>We conducted a retrospective study, reviewing the electronic medical records of patients with locally advanced esophageal cancer treated with Chemotherapy-Radiotherapy at the National Institute of Oncology from 2012 to 2022. Results were evaluated using the Kaplan Meier method, long rank test and a multivariate analysis with Cox regression. <i>Objective: </i>to evaluate the survival results in patient with locally advanced esophageal cancer treated with chemotherapy-radiotherapy. <i>Results: </i>94 patients were evaluated, with a mean age of 64 years. The median time to progression (TPP) was 6 months and the median overall survival (OS) was 9 months. 69% patient has Eastern Cooperative Oncology Group (ECOG) 1, with a predominance of squamous histology in 89% and the degree of differentiation moderately differentiated in 55.3%. The main chemotherapy treatment was based on a scheme of weekly Carboplatin plus Paclitaxel in 41.5%, of which 66% received a dose of radiotherapy ≥45 Gy, with a 5-week extension time. A post-treatment radiographic response was evidenced with a clinical benefit of 36.2% and an objective response of 27.7%. The main adverse effects were dysphagia (16%), neutropenia (8.3%), nausea and vomiting (7.4%), and weight loss (7.4%). When analyzing the associated factors in relation to OS, in the multivariate analysis, the ECOG and the well-differentiated histological grade turned out to be significant association factors for better OS; but for the TTP, there were no associated factors identified when performing multivariate analysis. <i>Conclusions: </i>In this retrospective analysis, we found a median TTP of 6 months and a median OS of 9 months, which is below the values in the literature. The ECOG and the degree of differentiation were the factors associated with a better overall survival. Hematological and gastrointestinal adverse events were the most reported. It is important to choose patients in the best clinical condition for concomitant treatment with CT/RT to achieve better clinical results.