Optimal Timing of Early Versus Delayed Radiotherapy for Inoperable Stage IV Esophageal Cancer

Abstract

Long-term survival of inoperable stage IV esophageal cancer is rare, studies recommend chemoradiation therapy as the preferred strategy for advanced esophageal cancer. It is unclear whether to use radiotherapy in the early treatment period, or whether radiotherapy should be delayed until tumor progression occurs. We sought to understand if the timing of radiotherapy with respect to cisplatin-based chemotherapy would influence survival when treating stage IV esophageal cancer. A total of 461 patients with stage IV esophageal cancer according to the American Joint Committee on Cancer Seventh Edition tumor node metastasis staging system who underwent cisplatin-based chemotherapy and radiotherapy between January 2011 and June 2015 were included in a retrospective analysis. Patients were categorized as having early versus delayed radiotherapy to compare their treatment outcomes. Median age at the time of diagnosis was 62 years (range, 32 to 76 years). The majority of patients were men (70.3%) with squamous carcinoma (96.7%). Follow-up was complete in all patients for a median of 22 months (range, 2 to 50 months). At 10 weeks, there were 3 CR (1.5%), 95 PR (48.5%) in the early radiotherapy group, and 3 CR (1.1%), 102 PR (38.5%) in the delayed radiotherapy group, respectively. There was significant difference in clinical benefit rate (CR+PR+SD) between the two groups (81.6% vs. 64.5%, P = 0.000). Patients who underwent early radiotherapy had superior median progression-free survival and a trend toward longer median overall survival compared to those with delayed radiotherapy (8.7 months vs. 7.3 months, P = 0.002 and 16.8 months vs. 14.8 months, P = 0.056, respectively).Patients who had multi-organs metastasis had an inferior median overall survival compared to those with single organ metastasis (P = 0.017). Treatment toxicities were comparable between the two groups. Our results may suggest that early radiotherapy is more effective than delayed radiotherapy with respect to cisplatin-based chemotherapy to treat inoperable advanced esophageal cancer.Abstract 2338; Table 1Baseline characteristics of the 461 esophageal cancer patientsCharacteristicEarly RT (n = 196)Delayed RT (n = 265)P valueNo.%No.%SexMale13267.319272.50.113 Female6432.77327.5Age, years Range32-7537-76 Median6162Performance status 0105.1124.50.826 115880.621380.4 22814.34015.1Histology Squamous carcinoma19096.925696.6 Adenocarcinoma63.193.4Tumor site of esophagus Cervical105.1114.20.170 Upper thoracic3115.82911.0 Middle thoracic10654.115257.4 Lower thoracic4925.07327.5Metastatic location Distant LN16885.721982.60.355 Lung5226.59234.7 Liver2311.75621.1 Bone2814.33111.7Adrenal gland10.510.24 Brain10.5-- Two more organs7437.81060.4Chemotherapy regimen CP10352.613852.10.828 CF9347.412747.9Abbreviations: LN, lymph node; TP, cisplatin plus paclitaxel; CF, cisplatin plus fluorouracil. Open table in a new tab