PRIMARY TUMOR STATUS AFFECTS ON THE TREATMENT PROCESS AND THE OUTCOME OF ESOPHAGEAL CANCER PATIENTS

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PRIMARY TUMOR STATUS AFFECTS ON THE TREATMENT
PROCESS AND THE OUTCOME OF ESOPHAGEAL CANCER
PATIENTS TREATED BY RADIATION THERAPYRESULTS OF
THE PATTERNS OF CARE STUDY

• Masahiro Kenjo1), Takashi Uno2), Masahiko
  Oguchi3),
• Yuji Murakami1), Kotaro Gomi3), Takashi
  Yamashita3),
• Mari Shimada4), Daisuke Yamahana4), Teruki
  Teshima4),
• Japanese PCS Working Subgroup of Esophageal Cancer

1) Hiroshima University, Hiroshima, Japan 2)
Chiba University, Chiba, Japan 3) Cancer
Institute, Tokyo, Japan 4) Osaka University,
Osaka, Japan
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Purpose

• The purpose of this study is to present the
  results of the Patterns of Care Study (PCS) on
  radiation therapy (RT) for esophageal cancer.
• This study focuses on the impact of the primary
  tumor status (T stage) affecting on the
  Treatment Process and Outcome.

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Materials and Methods

• PCS data format for esophageal cancer was
  imported to Japan from US courtesy of the
  American College of Radiology and was modified to
  be used in Japan.
• A national survey of 76 facilities including both
  academic and non-academic institutions was
  conducted using the original two-stage cluster
  sampling.
• The institutions and the patients were randomly
  sampled under the criteria and were surveyed by
  extramural audits .
• Statistical significance was tested by the
  chi-squared test.

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Patterns of Care Study PCS
All Radiotherapy Institutions (Stratification)
Random Sampling 1
Selected Institutions
Eligibility Criteria
Eligible Cases
Random Sampling 2
Selected Cases
Extramural Audit
Investigated Cases
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Institution Strata Eligibility Criteria

• A Academic Institutions
• (University Hospital, Cancer Center)
• A1 New RT Cases ?430 Pts./year
• A2 New RT Cases lt430 Pts./year
• BNon-Academic Institutions
• (Other Hospitals)
• B1 New RT Cases ?130 Pts./year
• A2 New RT Cases lt130 Pts./year

• Start RT between Jan. 1999 and Dec. 2001
• Tumor main location thoracic esophagus
• (include abdominal esophagus beneath diaphragm)
  
• Histology
• Squamous CC, Adenosquamous CC, Adenocarcinoma
• Exclude distant organic metastasis (M1 by lymph
  node eligible)
• Karnofsky Performance Status gt 60
• Exclude double cancer cases within 5 years

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Patients
Clinical T stage (UICC 6th ed.)

• Age 46-94 y (median 71y)
• Sex Male 85 Female 15
• Histology Squamous cell carcinoma 99
• Main tumor location
• Upper 20, Middle 56, Lower24

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Karnofsky Performance Status Score at
pre-treatment
T1 vs. T2-4 P0.001
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Pre-treatment Evaluations
Esophagram
Endoscopy
()
P0.152
P0.064
Chest CT
Endoscopic Ultrasound
P0.108
P0.001
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Treatment Combinations
()
External RTx
Brachytherapy
P0.338
P0.002
Chemotherapy
Endoscopic Mucosal Resection
P0.001
P0.001
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External RT dose

Median 60Gy 61Gy
(Gy)
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External RT to Nodal Area gt 40 Gy
()
Supraclavicla
P0.011
Mediastinum
P0.022
Abdomen
P0.653
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Treatment Delivery and Outcome
()
Admission for RTx
Completion of planned Tx
P0.253
P0.044
Residual at finish RTx
Acute Adverse Effects gt G2
P0.001
P0.386
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Overall Survival(T stage)
Median Follow up for survivers 9M
2y Rate T1 72 T2 53 T3 41 T4 27
T1
T2
T1 vs. T2-4
T3
P0.001
T4
Years after RT
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Conclusions

• Tumor evaluation with EUS might become essential
  for early stage disease.
• Total external RT dose and longitudinal field
  size were almost same in early and advanced
  stage.
• Chemotherapy was aggressively used for advanced
  stage patients despite more poor KPS patients
  included.
• Clinical T stage was significantly correlated
  with the overall survival.