Which Therapies Improve Survival Most in Esophageal Cancer?

TOPLINE:
Perioperative chemotherapy as well as neoadjuvant chemoradiation therapy followed by surgery (trimodality therapy) are associated with improved overall survival in patients with locally advanced esophageal cancer compared with chemoradiation and radiotherapy alone, according to a retrospective study. Despite the benefits, perioperative chemotherapy is the least used approach.
METHODOLOGY:
Studies have demonstrated the efficacy of perioperative chemotherapy for treating esophageal adenocarcinoma as well as trimodality therapy for managing esophageal cancer, but survival outcomes associated with different treatment approaches in the clinical setting are not well defined, the researchers explained.
In the current analysis, researchers compared real-world survival outcomes associated with perioperative chemotherapy, trimodality therapy, radiotherapy, and definitive chemoradiation therapy among patients with locally advanced stages II-III esophageal cancer.
Researchers conducted a retrospective cohort study using data from the National Cancer Database, which included 57,116 patients (median age, 64 years) with T2-T4 esophageal carcinoma who were treated from 2006 to 2020. Among those included, 53.2% were aged more than 65 years and 6.7% were aged less than 50 years.
The patients received perioperative chemotherapy (0.5%), trimodality therapy (37.9%), definitive chemoradiation (56.9%), or radiotherapy alone (4.7%), and researchers compared survival outcomes among the groups.
The survival outcomes for patients with esophageal squamous cell carcinoma, those with esophageal adenocarcinoma, and those aged above 65 years were also evaluated. The median follow-up duration for all patients was 73.7 months.
TAKEAWAY:
Perioperative chemotherapy was associated with a median overall survival of 66.2 months — significantly longer than definitive chemoradiation (18.1 months), trimodality therapy (43.9 months), and radiotherapy alone (13.5 months; all P < .001).
Compared with definitive chemoradiation, perioperative chemotherapy (adjusted hazard ratio [aHR], 0.33; P < .001) and trimodality therapy (aHR, 0.45; P < .001) were associated with significantly improved overall survival, while radiotherapy alone was associated with worse outcomes (aHR, 1.37; P < .001)
Among patients aged more than 65 years, perioperative chemotherapy and trimodality therapy were associated with improved median overall survival — 56.7 months and 40.1 months, respectively — compared with the other treatment modalities (all P < .001).
Patients with squamous cell carcinoma had worse survival outcomes compared with those with adenocarcinoma (aHR, 0.87; P < .001). Most patients who received perioperative chemotherapy had adenocarcinoma and had the greatest survival outcomes. Poor performance status was also associated with worse prognosis (aHR, 1.16; P < .001).
IN PRACTICE:
“These findings may help bridge the gap” between clinical trial data and real-world clinical outcomes, the authors wrote. Patient characteristics, such as cancer subtype, age, and performance status, were associated with treatment outcomes, and perioperative chemotherapy was “underused and was associated with the greatest improvement in survival,” the authors added.
SOURCE:
The study, led by Won Jin Jeon, MD, Loma Linda University in Loma Linda, California, was published online in JAMA Network Open.
LIMITATIONS:
This study was limited by its retrospective design and small sample size of the perioperative chemotherapy group.
DISCLOSURES:
The authors did not declare any funding information. No relevant conflicts of interest were disclosed.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
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