1. Trends in treatment and overall survival among patients with proximal esophageal cancer
- Author
-
Evelien J. M. de Jong, Grard A. P. Nieuwenhuijzen, Hanneke W. M. van Laarhoven, Frank J. P. Hoebers, Marije Slingerland, Liselot B.J. Valkenburg-van Iersel, Paul M. Jeene, Nadia Haj Mohammad, Valery E.P.P. Lemmens, Tom Rozema, Chantal V. Hoge, Heike I. Grabsch, Sandra M. E. Geurts, Vivianne C. G. Tjan-Heijnen, Margreet van Putten, Judith de Vos-Geelen, Graduate School, Oncology, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, Public Health, Interne Geneeskunde, MUMC+: MA Medische Oncologie (9), RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Pathologie, RS: GROW - R2 - Basic and Translational Cancer Biology, Radiotherapie, and MUMC+: MA Maag Darm Lever (9)
- Subjects
Male ,Survival ,Esophageal Neoplasms ,SURGERY ,medicine.medical_treatment ,Esophageal cancer ,Kaplan-Meier Estimate ,Gastroenterology ,Upper thoracic ,Medicine ,Registries ,Practice Patterns, Physicians' ,Outcome ,Netherlands ,education.field_of_study ,Proximal ,General Medicine ,Chemoradiotherapy ,CHEMOTHERAPY ,Middle Aged ,Survival Rate ,medicine.anatomical_structure ,Treatment Outcome ,Chemotherapy, Adjuvant ,Cervical ,Female ,SQUAMOUS-CELL CARCINOMA ,RADIOTHERAPY ,medicine.medical_specialty ,Population ,IMPROVEMENT ,Esophagus ,SDG 3 - Good Health and Well-being ,Internal medicine ,Retrospective Cohort Study ,Humans ,education ,Aged ,Retrospective Studies ,Chemotherapy ,business.industry ,MORTALITY ,medicine.disease ,Confidence interval ,Cancer registry ,Radiation therapy ,Treatment ,Esophagectomy ,VOLUME ,Trends ,business ,Rare disease - Abstract
BACKGROUNDThe management of proximal esophageal cancer differs from that of tumors located in the mid and lower part of the esophagus due to the close vicinity of vital structures. Non-surgical treatment options like radiotherapy and definitive chemoradiation (CRT) have been implemented. The trends in (non-)surgical treatment and its impact on overall survival (OS) in patients with proximal esophageal cancer are unclear, related to its rare disease status. To optimize treatment strategies and counseling of patients with proximal esophageal cancer, it is therefore essential to gain more insight through real-life studies.AIMTo establish trends in treatment and OS in patients with proximal esophageal cancer.METHODSIn this population-based study, patients with proximal esophageal cancer diagnosed between 1989 and 2014 were identified in the Netherlands Cancer Registry. The proximal esophagus consists of the cervical esophagus and the upper thoracic section, extending to 24 cm from the incisors. Trends in radiotherapy, chemotherapy, and surgery, and OS were assessed. Analyses were stratified by presence of distant metastasis. Multivariable Cox proportional hazards regression analyses was performed to assess the effect of period of diagnosis on OS, adjusted for patient, tumor, and treatment characteristics.RESULTSIn total, 2783 patients were included. Over the study period, the use of radiotherapy, resection, and CRT in non-metastatic disease changed from 53%, 23%, and 1% in 1989-1994 to 21%, 9%, and 49% in 2010-2014, respectively. In metastatic disease, the use of chemotherapy and radiotherapy increased over time. Median OS of the total population increased from 7.3 mo [95% confidence interval (CI): 6.4-8.1] in 1989-1994 to 9.5 mo (95%CI: 8.1-10.8) in 2010-2014 (logrank P CONCLUSIONOS significantly improved in non-metastatic proximal esophageal cancer, likely to be associated with an increased use of CRT. Patterns in metastatic disease did not change significantly over time.
- Published
- 2019