Hospital Volume Predicts Guideline Concordant Care in Stage III Esophageal Cancer

2021 ◽  
Author(s):  
Akash H. Adhia ◽  
Joseph M. Feinglass ◽  
Cary Jo Schlick ◽  
Ryan P. Merkow ◽  
Karl Y. Bilimoria ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Hospital Volume ◽  
Stage Iii

Radio(chemo)therapy Plus Resection Versus Radio(chemo)therapy Alone for the Treatment of Stage III Esophageal Cancer*

2007 ◽  
Vol 183 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Dirk Rades ◽  
Rainer Schulte ◽  
Emre F. Yekebas ◽  
Nils Homann ◽  
Steven E. Schild ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Stage Iii

Impact of lung and heart dose on survival after radiotherapy for esophageal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 3-3 ◽  
Author(s):  
Patrick Oh ◽  
Minsi Zhang ◽  
Paul Brady ◽  
Ellen Yorke ◽  
Elizabeth Won ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Independent Predictor ◽  
Performance Status ◽  
Locally Advanced ◽  
Stage Iii ◽  
Advanced Lung Cancer ◽  
Lung Dose ◽  
Cardiac Dose ◽  
The Impact

3 Background: Chemoradiation is an essential tool in treatment of localized esophageal cancer. Recent data indicates that cardiac dose is an independent predictor of survival after chemoradiation for locally advanced lung cancer. However, the impact of normal tissue dose in esophageal cancer has not been well characterized. We investigated cardiac and pulmonary dose-volume histogram (DVH) metrics as potential predictors of overall survival (OS) after chemoradiation for esophageal cancer. Methods: We reviewed 453 consecutive patients with stage I-III esophageal cancer treated with definitive or preoperative chemoradiation (median dose 50.4 Gy in 28 fractions) between 2007 and 2015 at our center. Most (n = 442) received intensity-modulated radiation therapy. Radiation plans were reviewed and multiple DVH metrics for heart (max and mean dose, V5Gy, V10Gy, V20Gy, V30Gy, and V40Gy) and lung (mean dose, V5Gy, and V20Gy) were extracted for analysis. Other clinical covariates (surgery, performance status, stage, and histology) were recorded. Cox univariate (UVA) and multivariate (MVA) regression was used to analyze the association of these factors with overall survival. Results: Median follow-up for surviving patients was 28.4 months. On UVA, older age, lower performance status, Stage III disease, lack of surgery, heart V40Gy, lung V5Gy, lung V20Gy, and lung mean dose were significantly associated with decreased survival. On MVA, surgery (p = 0.008), stage III disease (p < 0.0002) and lung V20Gy (p = 0.0389) remained significant, while heart V40Gy did not (p = 0.211). Patients with lung V20Gy< 20% had a median survival of 44.0 months, compared to 24.0 months for patients with lung V20Gy≥20%. Conclusions: This comprehensive dosimetric analysis of heart and lung dose in a large cohort of esophageal cancer patients suggests that lung dose is a significant independent predictor of survival. Cardiac dose was not independently predictive after adjusting for lung dose and other clinical factors. This data suggests that esophageal cancer outcomes may be improved by minimizing lung dose, particularly the volume receiving 20Gy or more, and provides further rationale for pursuing new techniques to reduce lung dose, such as proton therapy.

Evaluation of the Glasgow Prognostic Score in patients receiving chemoradiotherapy for stage III and IV esophageal cancer

2015 ◽  
Vol 29 (8) ◽  
pp. 1071-1080 ◽  
Author(s):  
J. Kimura ◽  
C. Kunisaki ◽  
H. Makino ◽  
T. Oshima ◽  
M. Ota ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Stage Iii ◽  
The Glasgow Prognostic Score

RA03.01: A POPULATION-BASED STUDY ON LYMPH NODE RETRIEVAL IN PATIENTS WITH ESOPHAGEAL CANCER: RESULTS FROM THE DUTCH UPPER GASTROINTESTINAL CANCER AUDIT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 22-23
Author(s):  
Leonie Van Der Werf ◽  
Johan Dikken ◽  
Mark I Van Berge Henegouwen ◽  
Valery Lemmens ◽  
Grard A P Nieuwenhuijzen ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Neoadjuvant Therapy ◽  
Hospital Volume ◽  
Conflicts Of Interest ◽  
Neoadjuvant Chemoradiotherapy ◽  
Charlson Score ◽  
Short Term ◽  
Lymph Node Retrieval

Abstract Background For esophageal cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study was to analyze the number of retrieved LNs in the Netherlands, to assess factors associated with LN yield and to explore the association with short-term outcomes. Methods For this retrospective national cohort study, patients with an esophageal carcinoma who underwent esophagectomy between 2011–2016 were included. Primary outcome was the number of retrieved LNs. Associations were tested with univariable and multivariable regression analysis for the association with ≥ 15 LNs. Results 3970 patients were included. Between 2011–2016 the median number of LNs increased from 15 to 20. Factors independently associated with ≥ 15 LNs were: 0–10 kg preoperative weight loss (versus: unknown weight loss, odds ratio [95% confidence interval]: 0.71[0.57–0.88]), Charlson-score 0 (versus: Charlson-score 2: 0.76[0.63–0.92]), cN2-category (reference: cN0, 1.32[1.05–1.65]), no neoadjuvant therapy and neoadjuvant chemotherapy (reference: neoadjuvant chemoradiotherapy, 1.73[1.29–2.32], 2.15[1.54–3.01]), minimally invasive transthoracic (reference: open transthoracic, 1.46[1.15–1.85]), open transthoracic (versus open and minimally invasive transhiatal, 0.29[0.23–0.36] and 0.43[0.32–0.59], hospital volume of 26–50 or > 50 resections/year (reference: 0–25, 1.94[1.55–2.42], 3.01[2.36–3.83]) and year of surgery (reference: 2011, ORs: 1.48, 1.53, 2.28, 2.44, 2.54). There was no association of ≥ 15 LNs with short-term outcomes. Conclusion The number of LNs retrieved increased between 2011 and 2016. Weight loss, Charlson score, cN-category, neoadjuvant therapy, surgical approach, year of resection and hospital volume were all associated with increased LN yield. The retrieval of ≥ 15 LNs was not associated with increased postoperative morbidity/mortality. Disclosure All authors have declared no conflicts of interest.

Association between heart dosimetric parameters, cardiac events and overall survival for patients with stage III esophageal cancer treated with definitive radiotherapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15561-e15561
Author(s):  
Guoxin Cai ◽  
Jinming Yu ◽  
Xue Meng
Keyword(s):  
Esophageal Cancer ◽  
Smoking Status ◽  
Performance Status ◽  
Tumor Location ◽  
Stage Iii ◽  
Cardiac Events ◽  
Definitive Radiotherapy ◽  
Heart Dose ◽  
Pericardial Diseases ◽  
Ischemic Diseases

e15561 Background: Heart exposure to irradiation can cause cardiac events (CEs). The impact of radiation heart dosimetric parameters (RHDPs) on overall survival (OS) in esophageal cancer is not known. The aim of this study was to determine the association between heart dosimetric parameters and CEs and OS in patients with stage III esophageal cancer. Methods: 346 patients with esophageal cancer treated with definitive radiotherapy (RT) from 2011 to 2013 were enrolled retrospectively. We mainly observed three types of CEs: ischemic diseases (myocardial infarction and unstable angina), pericardial diseases (symptomatic effusion and pericarditis), and arrhythmia. We performed logistic regression or Cox proportional hazards models to evaluate the relationship between RHDPs, CEs and OS. Results: Median follow-up was 28 months and median prescribed doses was 60 Gy. Three and five-year OS was 43.9% and 16.8%, respectively. The number of patients who had ischemic diseases, pericardial diseases and arrhythmia in five years since they received treatment was 19, 12 and 26, respectively. Ischemic diseases was associated with pre-existing heart disease (P = .0016) and percentage of heart volume receiving ≥5 Gy (heart V5) (P = .0037), arrhythmia was associated with pre-existing heart disease (P = .0020), heart V5 (P = .0003) and mean heart dose (MHD) (P = .0021), but pericardial diseases was not correlated with RHDPs. In univariate analysis, smoking status, performance status, tumor location, lung V5, mean lung dose (MLD), heart V30, MHD and gross tumor volume (GTV) were significantly associated with three-year OS, and performance status, tumor location, concurrent or sequential chemotherapy, lung V5, heart V5, heart V30, MHD and GTV were correlated with five-year OS. In multivariate analysis, only poor performance status (hazard ratio (HR) 1.56; 95% confidence interval (CI), 1.16-2.10; P = .003 and HR 1.80; 95% CI, 1.15-2.82; P = .010) and larger GTV (HR 1.53; 95% CI, 1.14-2.05; P = .004 and HR 1.64; 95% CI, 1.07-2.49; P = 0.023) independently indicate worse three and five-year OS, and smoking status (HR 1.37; 95% CI, 1.03-1.82; P = 0.032) predict three-year OS only. Conclusions: Heart dose is associated with the occurrence of CEs, but it could not independently predict OS for patients with stage III esophageal cancer treated with definitive radiotherapy.

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