National practice of radiation therapy and chemoradiation therapy for esophageal cancer in Japan; Results of Patterns of Care Study (1999–2001)

Abstract

4193 Background: Patterns of Care Study (PCS) was conducted to reveal the current status of radiation therapy (RT) and chemoradiation therapy (CRT) for esophageal cancer in Japan. Methods: PCS data format for esophageal cancer was imported to Japan from the United States courtesy of the American College of Radiology. A national survey of 76 facilities including both academic and nonacademic institutions was conducted using the original two-stage cluster random sampling. Eligible criteria were as follows; start radiation therapy (RT) between 1999 and 2001, no evidence of distant organic metastasis (M1b), squamous cell, adenosquamous cell, or adenocarcinoma histology, Karnofsky performance status 60–100, tumors in the thoracic esophagus, and no prior malignancies within the last 5 years. Detailed information was accumulated on 621 patients. Patients were classified according to 1997 UICC criteria. Results: Median age of patients was 68 years. 87% were male and 13% were female. 99% had squamous cell histology. 54% had main lesion in middle thoracic esophagus and 3% had in beneath diaphragm. 13% had stage I disease, 32% had stage IIA or IIB, 43% had stage III and 10% had stage IV disease. All patients received RT. 63% received chemotherapy and 32% received esophagectomy. Patients aged 75 years or more were more frequently treated by RT alone (55%) than by CRT (36%). Preoperative CRT was used for 17% and definitive CRT was used for 39%. Median total dose of RT was 60Gy for all patients, 40Gy for preoperative CRT group and 60Gy in definitive CRT group. 49% of the CRT group received more than 60Gy of external RT. Among CRT group, 88% received chemotherapy concurrently. Cisplatin was used for 85% of CRT group and 5FU was for 98%. Administration schedule of concurrent chemotherapy was daily for 67% of the CRT patients, weekly for 9% and tri-weekly or monthly for 12%. 2% of the patients were treated on approved investigational protocols. Conclusions: CRT has become common for esophageal cancer but used not frequently for elderly patients. High total RT dose was used for CRT patients. Cisplatin and 5FU are the main agents for concurrent CRT. Daily administration schedule was widely used in Japan. No significant financial relationships to disclose.