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Induction chemoradiation therapy prior to esophagectomy is associated with superior long-term survival for esophageal cancer.

Publication ,  Journal Article
Speicher, PJ; Wang, X; Englum, BR; Ganapathi, AM; Yerokun, B; Hartwig, MG; D'Amico, TA; Berry, MF
Published in: Dis Esophagus
2015

The purpose of this study was to examine the role of induction chemoradiation in the treatment of potentially resectable locally advanced (T2-3N0 and T1-3N+) esophageal cancer utilizing a large national database. The National Cancer Data Base (NCDB) was queried for all patients undergoing esophagectomy for clinical T2-3N0 and T1-3N+ esophageal cancer of the mid- or lower esophagus. Patients were stratified by the use of induction chemoradiation therapy versus surgery-first. Trends were assessed with the Cochran-Armitage test. Predictors of receiving induction therapy were evaluated with multivariable logistic regression. A propensity-matched analysis was conducted to compare outcomes between groups, and the Kaplan-Meier method was used to estimate long-term survival. Within the NCDB, 7921 patients were identified, of which 6103 (77.0%) were treated with chemoradiation prior to esophagectomy, while the remaining 1818 (23.0%) were managed with surgery-first. Use of induction therapy increased over time, with an absolute increase of 11.8% from 2003-2011 (P < 0.001). As revealed by the propensity model, induction therapy was associated with higher rates of negative margins and shorter hospital length of stay, but no differences in unplanned readmission and 30-day mortality rates. In unadjusted survival analysis, induction therapy was associated with better long-term survival compared to a strategy of surgery-first, with 5-year survival rates of 37.2% versus 28.6%, P < 0.001. Following propensity score matching analysis, the use of induction therapy maintained a significant survival advantage over surgery-first (5-year survival: 37.9% vs. 28.7%, P < 0.001). Treatment with induction chemoradiation therapy prior to surgical resection is associated with significant improvement in long-term survival, even after adjusting for confounders with a propensity model. Induction therapy should be considered in all medically appropriate patients with resectable cT2-3N0 and cT1-3N+ esophageal cancer, prior to esophagectomy.

Duke Scholars

Published In

Dis Esophagus

DOI

EISSN

1442-2050

Publication Date

2015

Volume

28

Issue

8

Start / End Page

788 / 796

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Retrospective Studies
  • Propensity Score
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Induction Chemotherapy
  • Humans
 

Citation

APA
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ICMJE
MLA
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Speicher, P. J., Wang, X., Englum, B. R., Ganapathi, A. M., Yerokun, B., Hartwig, M. G., … Berry, M. F. (2015). Induction chemoradiation therapy prior to esophagectomy is associated with superior long-term survival for esophageal cancer. Dis Esophagus, 28(8), 788–796. https://doi.org/10.1111/dote.12285
Speicher, P. J., X. Wang, B. R. Englum, A. M. Ganapathi, B. Yerokun, M. G. Hartwig, T. A. D’Amico, and M. F. Berry. “Induction chemoradiation therapy prior to esophagectomy is associated with superior long-term survival for esophageal cancer.Dis Esophagus 28, no. 8 (2015): 788–96. https://doi.org/10.1111/dote.12285.
Speicher PJ, Wang X, Englum BR, Ganapathi AM, Yerokun B, Hartwig MG, et al. Induction chemoradiation therapy prior to esophagectomy is associated with superior long-term survival for esophageal cancer. Dis Esophagus. 2015;28(8):788–96.
Speicher, P. J., et al. “Induction chemoradiation therapy prior to esophagectomy is associated with superior long-term survival for esophageal cancer.Dis Esophagus, vol. 28, no. 8, 2015, pp. 788–96. Pubmed, doi:10.1111/dote.12285.
Speicher PJ, Wang X, Englum BR, Ganapathi AM, Yerokun B, Hartwig MG, D’Amico TA, Berry MF. Induction chemoradiation therapy prior to esophagectomy is associated with superior long-term survival for esophageal cancer. Dis Esophagus. 2015;28(8):788–796.
Journal cover image

Published In

Dis Esophagus

DOI

EISSN

1442-2050

Publication Date

2015

Volume

28

Issue

8

Start / End Page

788 / 796

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Retrospective Studies
  • Propensity Score
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Induction Chemotherapy
  • Humans