Patterns of treatment and outcome in patients with unresectable or inoperable esophageal cancer: A real world data

BackgroundEsophageal cancer is the eighth most common cancer in the world with a high mortality rate. Surgery, radiation and chemotherapy have been tried in various combinations to improve on the survival rates. Our study provides real world data from a South Asian country on patterns of treatment and outcome in patients with unresectable or inoperable esophageal cancer. Materials and MethodsThis study is a retrospective analysis of all consecutive esophageal cancer patients, with medically inoperable or unresectable disease, and treated with conformal radical radiotherapy at a tertiary cancer center from January, 2016 to December, 2017. Data regarding patients age, histology, location, pre-treatment imaging, disease stage, treatment details, compliance and response to treatment and status at last follow-up were retrieved from their file. Continuous and categorical variables were summarized by descriptive statistics. ResultsA total of 100 esophageal cancer patients with a mean age of 60.24 years were included in the study. 60% of the patients were male and upper one-third was the most common site involved. Squamous cell carcinoma was reported in 83% of the patients. About 70% of the patients had a T3/T4 disease and 44% also had nodal metastasis. The radiation dose ranged from 45Gy - 63Gy (median = 59.4Gy). Further, 15% and 54% of the patients received neoadjuvant and concurrent chemotherapy respectively. Radiation compliance was seen in 90% of the patients. With a median follow-up of 7 months (range 3-58 months), 80% of the patients were alive with 32.22% having no evidence of disease. Distant metastases and loco regional failure was seen in 32.22% and 28% of the patients respectively. ConclusionOur study showed that esophageal cancer is more common in elderly males. Adherence to a uniform treatment protocol using concurrent chemo radiation is difficult in clinical practice especially in resource constrained set up. Both distant metastases and loco regional failure continues to be a matter of concern. Further improvement in local control must be evaluated by either radiation dose escalation or novel combinations with chemotherapy and immunotherapy in large, multi centric trial settings.