Does race influence survival for esophageal cancer patients treated on theradiation and chemotherapy arm of RTOG #85-01?

Purpose: In reported retrospective non-randomized trials of treatment of es ophageal carcinoma, blacks have a lower survival from esophageal cancer tha n whites. None of these studies has accounted for the extent of disease, or the methods and quality of treatment. We reviewed the data that included o nly patients treated-on the chemoradiation arm of the RTOG-8501 esophageal carcinoma trial to see if there were differences in overall survival betwee n black and white patients receiving the same standard of care. Methods and Materials: One hundred-nineteen patients, 37 blacks and 82 whit es were evaluated who met the criteria for receiving chemoradiation of 5000 cGy and four courses of Cisplatin (75 mg/m(2)) and Fluorouracil (1000 mg/m 2 for 4 days). Results: Blacks had squamous histology only, with 86% of blacks having weig ht loss of 10 Ibs. or more compared to 56% of whites (p = 0.001). In additi on, blacks had larger tumors and more difficulty eating (p = 0.010). Overal l, there was no difference in the Kaplan-Meier median sur,survival estimate by race (p = 0.2757). Only when we limited the analysis to the "squamous h istology" subgroup, stratified according to age >70 vs. <70 years (p 0.0002 ), and nodal status (p = 0.0177) in a Cox regression model analysis, did ra ce appear to be a significant factor (p = 0.0012). However, using the entir e database, the age effect was found to be a "bimodal" effect, wherein the "youngest" (< age 60 years) and "oldest" patients (age > 70 years) did poor ly. Because of the dramatic differences in the age and histology distributi ons between blacks and whites, this issue could not be resolved in the subs et of squamous only who received chemoradiation. Conclusions: The increasing incidence of adenocarcinoma among white patient s without a corresponding increase of this histology in blacks reflects a d ifference in diet and or Lifestyle compared to blacks that deserves additio nal study. When treated aggressively with chemoradiation, race did not appe ar to be a statistically significant factor for overall survival. (C) 1999 Elsevier Science Inc.