TY - JOUR
T1 - Higher Doses of Neoadjuvant Radiation for Esophageal Cancer Do Not Affect the Pathologic Complete Response Rate or Survival
T2 - A Propensity-Matched Analysis
AU - Worrell, Stephanie G.
AU - Towe, Christopher W.
AU - A. Dorth, Jennifer
AU - Machtay, Mitchell
AU - Perry, Yaron
AU - Linden, Philip A.
N1 - Funding Information:
The NCDB is a hospital-based tumor registry jointly sponsored by the American College of Surgeons and the American Cancer Society. The NCDB captures data from hospitals accredited by the American College of Surgeons Commission on Cancer and includes more than 70% of all cases with newly diagnosed cancer nationwide. 9 Clinical staging in the NCDB is based on the American Joint Committee of Cancer (AJCC) edition corresponding with the year of diagnosis. We used clinical and pathologic T stages because these were consistent between the sixth and seventh editions, which spanned our study period. To keep the data consistent between patients treated at the time of the sixth- and seventh-edition AJCC staging, we also examined clinical and pathologic N stage by node-positive versus node-negative status and did not evaluate based on the number of positive lymph nodes. The NCDB is a joint project of the Commission on Cancer (CoC) between the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB were the source of the de-identified data used in this study. They have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
Publisher Copyright:
© 2019, Society of Surgical Oncology.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Background: Traditional neoadjuvant therapy for esophageal cancer has used chemoradiation doses greater than 45 Gy. This study aimed to examine the dose of preoperative radiation in relation to the pathologic complete response (pCR) rate and overall survival (OS) for patients with resectable esophageal cancer. Methods: The National Cancer Database was queried for all patients with esophageal or gastroesophageal junction cancer who received neoadjuvant chemoradiation (CRT) followed by esophagectomy between 2006 and 2015. The radiation doses were divided into four ranges based on Grays (Gy) received: less than 39.6 Gy, 39.60–44.99 Gy, 45–49.99 Gy, and 50 Gy or more. Results: The inclusion criteria were met by 10,293 patients. All patients received neoadjuvant CRT, with 689 patients (6.7%) receiving less than 39.6 Gy, 973 patients (9.5%) receiving 39.6–44.9 Gy, 3837 patients (37.3%) receiving 45–49.9 Gy, and 4794 patients (46.6%) receiving 50 Gy or more. The overall pCR rate was 17.2% (1769/10,293) and was significantly lower for those who received less than 39.6 Gy of radiation than for those who received 39.6 Gy or more (13.9% [96/689] vs. 17.4% [1673/9604]; p = 0.017). The median OS of 37.2 months was significantly better for those who received 39.6 Gy or more than for those who received less than 39.6 Gy (38 vs. 29.6 months (p < 0.0001). The pCR and OS did not differ between the three higher radiation doses (39.6–44.9 vs. 45–49.9 Gy vs. ≥ 50 Gy; pCR [p = 0.1] vs. OS [p = 0.097]). The patients who received 39.6–44.9 Gy were propensity matched with those who received 45 Gy or more of radiation. There remained no difference in pCR (p = 0.375) or OS (p = 0.957). Conclusions: In the United States, the heterogeneity in neoadjuvant CRT dosing is significant, with 84% of patients receiving more than 45 Gy. The benefit of neoadjuvant CRT in terms of pCR and overall survival is seen with doses of 39.6 Gy or more, but not with doses higher than 45 Gy.
AB - Background: Traditional neoadjuvant therapy for esophageal cancer has used chemoradiation doses greater than 45 Gy. This study aimed to examine the dose of preoperative radiation in relation to the pathologic complete response (pCR) rate and overall survival (OS) for patients with resectable esophageal cancer. Methods: The National Cancer Database was queried for all patients with esophageal or gastroesophageal junction cancer who received neoadjuvant chemoradiation (CRT) followed by esophagectomy between 2006 and 2015. The radiation doses were divided into four ranges based on Grays (Gy) received: less than 39.6 Gy, 39.60–44.99 Gy, 45–49.99 Gy, and 50 Gy or more. Results: The inclusion criteria were met by 10,293 patients. All patients received neoadjuvant CRT, with 689 patients (6.7%) receiving less than 39.6 Gy, 973 patients (9.5%) receiving 39.6–44.9 Gy, 3837 patients (37.3%) receiving 45–49.9 Gy, and 4794 patients (46.6%) receiving 50 Gy or more. The overall pCR rate was 17.2% (1769/10,293) and was significantly lower for those who received less than 39.6 Gy of radiation than for those who received 39.6 Gy or more (13.9% [96/689] vs. 17.4% [1673/9604]; p = 0.017). The median OS of 37.2 months was significantly better for those who received 39.6 Gy or more than for those who received less than 39.6 Gy (38 vs. 29.6 months (p < 0.0001). The pCR and OS did not differ between the three higher radiation doses (39.6–44.9 vs. 45–49.9 Gy vs. ≥ 50 Gy; pCR [p = 0.1] vs. OS [p = 0.097]). The patients who received 39.6–44.9 Gy were propensity matched with those who received 45 Gy or more of radiation. There remained no difference in pCR (p = 0.375) or OS (p = 0.957). Conclusions: In the United States, the heterogeneity in neoadjuvant CRT dosing is significant, with 84% of patients receiving more than 45 Gy. The benefit of neoadjuvant CRT in terms of pCR and overall survival is seen with doses of 39.6 Gy or more, but not with doses higher than 45 Gy.
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U2 - 10.1245/s10434-019-07849-z
DO - 10.1245/s10434-019-07849-z
M3 - Article
C2 - 31571054
AN - SCOPUS:85074041200
SN - 1068-9265
VL - 27
SP - 500
EP - 508
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 2
ER -
