Outcome of patients receiving radiation for cancer of the esophagus: Results of the 1992-1994 patterns of care study

Purpose: A patterns of Care Study examined the records of patients with eso phageal cancer (EC) treated with radiation in 1992 through 1994 to determin e the national practice processes of care and outcomes and to compare the r esults with those of clinical trials. Patients and Methods: A national survey of 63 institutions was conducted us ing two-stage cluster sampling, and specific information was collected on 4 00 patients with squamous cell (62%) or adenocarcinoma (37%) of the thoraci c esophagus who received radiation therapy (RT) as part of primary or adjuv ant treatment. Patients were staged according to a modified 1983 American J oint Committee on Cancer staging system. Fifteen percent of patients had cl inical stage (CS) I disease, 40% had CS II disease, and 30% had CS III dise ase. Twenty-six percent of patients underwent esophagectomy. Seventy-five p ercent of patients received chemotherapy; 84% of these received concurrent chemotherapy and radiation (CRT). Results: Significant variables for overall survival in multivariate analysi s include the use of esophagectomy (risk ratio [RR] = 0.62), the use of che motherapy (RR = 0.63), Karnofsky performance status (KPS) greater than 80 ( RR = 0.61), CS I or II disease (RR = 0.66), and facility type (RR = 0.72). Age, sex, and histology were not significant, Preoperative CRT resulted in a nonsignificantly higher a-year survival rate compared with definitive CRT alone (63% v 39%; P = .11), whereas 2-year survival by planned treatment r ather than treatment given was 47.7% for preoperative CRT and 35.4% for def initive CRT (P = .23). Definitive CRT compared with definitive PT alone res ulted in significantly higher 2-year survival (39% v 20.6%; P = .027) and l ower 5-year local regional failure (30% v 57.9%; P = .0031). Conclusion: This study confirms the value of CRT in EC treatment. It indica tes that the results obtained in practice settings nationwide are similar t o those obtained in clinical trials and that KPS and the 1983 clinical stag ing system are useful prognostic indicators. The suggested value of esophag ectomy and superiority of preoperative CRT over CRT alone in this study sho uld be tested in a randomized trial. J Clin Oncol 18:455-462. (C) 2000 by A merican Society of Clinical Oncology.