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Journal of Gastrointestinal Surgery

, Volume 23, Issue 4, pp 670–678 | Cite as

Influence of Neoadjuvant Radiation Dose on Patients Undergoing Esophagectomy and Survival in Locally Advanced Esophageal Cancer

  • Mickey S. Ising
  • Katy Marino
  • Jaimin R. Trivedi
  • Adam A. Rojan
  • Neal E. Dunlap
  • Victor van Berkel
  • Matthew P. FoxEmail author
2018 SSAT Plenary Presentation

Abstract

Background

Neoadjuvant chemoradiotherapy followed by resection is standard of care for patients with locally advanced esophageal cancer, however, a significant portion of these patients do not undergo surgical intervention. This study evaluates radiation dose and other factors associated with undergoing esophageal resection and their impact on outcomes including survival.

Methods

Patients diagnosed with esophageal cancer between 2010 and 15 were queried from the National Cancer Database and stratified into low-dose radiation (41.4 Gy) (LDR) or high-dose radiation (50.0 or 50.4 Gy) (HDR) groups. Multivariable Logistic and Cox Regression analyses were performed to investigate the effect of multiple variables on the likelihood of undergoing esophagectomy and overall survival, respectively. Propensity score matching was performed to reduce bias between groups.

Results

A total of 3633 patients met study criteria with 3005 (82.7%) undergoing esophagectomy. A greater proportion received HDR (3163 (87.1%)) than LDR (470 (12.9%)). The use of LDR increased from 4.7% (n = 22) in 2010 to 20.7% (n = 154) in 2015. Factors associated with undergoing esophagectomy included LDR, adenocarcinoma histology, and younger age. Radiation dosage did not impact overall survival, but undergoing esophagectomy was associated with improved survival. After propensity matching, a greater portion of the LDR group underwent esophagectomy (87.0 vs 81.1%, p = 0.013). There was no difference in R0 3 resection (93.2 vs 92.4%, p = 0.678) or complete pathologic response (19.3 vs 21.5%, p = 0.442) between LDR and HDR groups.

Conclusion

The use of LDR is increasing but still underutilized. LDR is associated with increased rates of esophagectomy without negatively impacting overall survival, R0 resection, or complete pathologic response.

Keywords

Radiation dosage Esophagectomy Esophageal cancer 

Notes

Acknowledgments

Presented at Digestive Disease Week 2018, June 5, 2018, Washington DC.

Author Contributions

Per the guidelines of the International Committee of Medical Journal Editors (ICMJE), all persons listed as authors meet all of the following criteria:

- Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work.

- Drafting the work or revising it critically for important intellectual content.

- Final approval of the version to be published.

- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Louisville School of MedicineLouisvilleUSA
  2. 2.Department of Cardiovascular and Thoracic SurgeryUniversity of Louisville School of MedicineLouisvilleUSA
  3. 3.Division of Medical Oncology and Hematology, Department of MedicineUniversity of Louisville School of MedicineLouisvilleUSA
  4. 4.Department of Radiation Oncology, Brown Cancer CenterUniversity of Louisville School of MedicineLouisvilleUSA

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