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• W2758626069 abstract "Current NCCN guidelines for patients with newly diagnosed metastatic esophageal squamous cell carcinoma (ESCC) recommend treatment with systemic therapy, with radiation therapy (RT) reserved for palliation. However, in 2016, a Chinese randomized phase II trial of 60 patients (Li et al) showed that those with stage IV ESCC who received definitive chemoradiation had nearly double the median survival compared to chemotherapy alone. Based on this provocative finding, this NCDB study was performed to determine whether similar outcomes were observed in the U.S. population. Patients with clinical M1 ESCC from 2004-2013 who received either no RT or definitive RT (DRT, 45-70 Gy) and had complete treatment and survival information were identified in the NCDB; patients treated to palliative doses (8-30 Gy) were excluded. The effects of DRT on overall survival (OS) were assessed with Cox proportional hazards regression in univariate (UVA) and multivariable (MVA) analyses. Kaplan Meier analysis was done to estimate OS and rates were compared using the log-rank test. As DRT is not standard of care, logistic regression was done to identify what factors correlated with its use. 2639 patients met inclusion criteria: 1124 (43%) received DRT at a median dose of 50.4 Gy/28 fx and 1515 received no RT (57%). For those receiving DRT vs. not, median age was 64 vs. 65, 77% vs. 74% of patients were Charlson 0, and 76% vs. 71% had T3-4 tumors, respectively. On MVA, DRT was associated with improved OS (HR 0.61, median survival: 10.9 months with DRT vs. 4.2 months without, p<0.0001). Significant predictors of worse OS observed on MVA included T4 disease as compared to T0-T3 (HR 1.3, p<0.0001), absence of chemotherapy (HR 2.4, p<0.0001), and Charlson score ≥ 1 (HR 1.2, p<0.05). On MVA, use of DRT correlated with treatment at a non-academic center (OR 1.3, p<0.01), receipt of chemotherapy (OR 6.9, p<0.0001), and T3 vs. T0-2 disease (OR 2.0, p<0.0001). Charlson score was not predictive of the delivery of DRT on MVA. When limiting the analysis to include only those who received chemotherapy (n=1742), DRT was still observed to improve median survival (7.9 months with chemotherapy alone vs. 11.9 months with chemotherapy + DRT, p<0.001). Treatment from 2011-2013 was associated with a lower likelihood of receiving DRT (OR 0.6, p=0.0001) when compared to 2004-2007. For those with cM1 ESCC, MVA showed DRT to be an independent predictor for survival. Though there is some potential for selection bias, this benefit persisted when limiting the analysis only to those who had also received chemotherapy; furthermore, the high percentage of cM1 patients receiving DRT likely minimizes some of the differences between groups. This result corroborates the findings of an earlier randomized trial. Despite its potential benefit, the use of this modality has decreased in recent years. Definitive RT may improve outcomes in carefully selected patients with newly diagnosed cM1 disease." @default.
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• W2758626069 date "2017-10-01" @default.
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• W2758626069 title "Definitive Radiation Therapy for Patients with Metastatic Esophageal Squamous Cell Carcinoma Improves Survival: An NCDB Analysis" @default.
• W2758626069 doi "https://doi.org/10.1016/j.ijrobp.2017.06.931" @default.
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