The evaluation and treatment of patients receiving radiation therapy for carcinoma of the esophagus - Results of the 1992-1994 patterns of care study

BACKGROUND. For the first time, a Patterns of Care Study (PCS) was conducte d in 1992-1994 to determine the national practice standards in evaluating a nd treating patients with esophageal carcinoma and to determine the degree to which clinical trials have been incorporated into national practice. METHODS. A national survey of 61 institutions using 2-stage cluster samplin g was conducted, and specific information was collected on 400 patients wit h squamous cell carcinoma or adenocarcinoma of the thoracic esophagus who r eceived radiation therapy (RT) as part of definitive or adjuvant management of their disease. Patients were staged according to a modified 1983 Americ an joint Committee on Cancer staging system. Chi-square tests for significa nt differences between academic and nonacademic institutions for a particul ar variable were performed. RESULTS. The median age of patients was 66.7 years (range, 26-89 years); 76 .5% were male and 23.5% were female. Karnofsky performance status was great er than or equal to 80 for 88.3% of patients. Squamous cell carcinoma was d iagnosed in 61.5% and adenocarcinoma in 36.8%. Fifteen percent were Clinica l Stage (CS) I, 39.5% CS II, and 29.5% CS III. Evaluative procedures includ ed endoscopy (>93%), computed tomography (CT) of the chest (86%), CT of the abdomen (75%), esophagography (68.5%), and endoscopic ultrasound (3.5%). E ndoscopic ultrasound and CT of the chest were performed significantly more frequently at academic than nonacademic facilities (6.1% vs. 1.0% and 91.9% vs. 81.3%, respectively). Three-quarters of all patients received chemothe rapy and RT and 62.5% received concurrent chemotherapy and RT as part of th eir treatment. Treatments included chemotherapy plus RT (54.0%), RT alone ( 20.3%), preoperative chemotherapy + RT (13.3%), postoperative chemotherapy + RT (7.7%), postoperative RT (3.5%), and preoperative RT (1.2%). The chemo therapeutic agents most frequently used were 5-fluorouracil (84%), cisplati n (64%), and mitomycin (9%); academic institutions used cisplatin significa ntly more often and mitomycin significantly less often than nonacademic ins titutions. Brachytherapy was used in 8.5% of cases. The median total dose o f external beam radiation was 50.4 gray and the median dose per fraction wa s 1.8 gray. CONCLUSIONS. This study establishes the national benchmarks for the evaluat ion and treatment of patients with esophageal carcinoma at radiation facili ties in the U.S. It also indicates that the majority of patients given RT a s a component of treatment for esophageal carcinoma receive chemoradiation rather than RT alone, as supported by clinical trials. Although some differ ences in the evaluation of esophageal carcinoma were noted between academic and nonacademic facilities, there was no difference in the frequency of us e of chemoradiation versus RT by facility type. Cancer 1999;85:2499-505. (C ) 1999 American Cancer Society.