ABSTRACT
BACKGROUND: Areas of Iran have among the highest incidences of esophageal cancer in the world. Definitive chemo-radiotherapy (DCRT) is used for locally advanced esophageal cancer and for inoperable tumors asan alternative to surgical treatment. MATERIALS AND METHODS: This retrospective study was conducted in North- West Iran 2006-2011, including 267 consecutive patients with non-metastatic esophageal cancer. Eligible inoperable patients were treated with DCRT or definitive radiotherapy (DRT) alone. Radiotherapy (RT) was delivered at 1.8-2 Gy/day for five consecutive days in a given week. Chemotherapy (CT) consisted of cisplatin and 5-fluorouracil. RESULTS: The median survival was 12.7 months with 1, 3 and 5 year survival rates of 55%, 18% and 11%, respectively. On univariate analysis, relations with age at diagnosis (p=0.015), N-stage (p=0.04), total dose of RT (p=0.001), fraction (p<0.001), Gap status (p=0.025), chemotherapeutic regimens (P=0.027), and 5-Fu Mg/m2 (P=0.004) were apparent. Comparing DCRT to DRT, there was a significant difference in survival. Multivariate analysis was performed for comparison between DCRT and DRT showed significant association with age group ≥65 to <65 (P=0.02; OR: 1.46), the total RT dose (Gy) ≥50 to <50 (P=0.01; OR: 0.65) and the fraction group ≥25 to <25 (P=<0.001; OR: 0.54). CONCLUSIONS: The survival rates of esophageal cancer treated with DCRT in North West of Iran is poor; therefore, early detection and improved treatment methods, with clinical trials are a high priority.
Subject(s)
Adenocarcinoma/mortality , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Squamous Cell/mortality , Chemoradiotherapy/mortality , Esophageal Neoplasms/mortality , Neoplasm Recurrence, Local/mortality , Adenocarcinoma/pathology , Adenocarcinoma/therapy , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Cisplatin/administration & dosage , Esophageal Neoplasms/pathology , Esophageal Neoplasms/therapy , Female , Fluorouracil/administration & dosage , Follow-Up Studies , Humans , Iran , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/therapy , Neoplasm Staging , Prognosis , Retrospective Studies , Survival RateABSTRACT
BACKGROUND: Esophageal cancer in Iran is the sixth most common cancer and is particularly important in east Azerbaijan. The aim of this study was to calculate survival rates and define prognostic factors in esophageal cancer patients. METHODS: In this study, all patients with esophageal cancer registered in the Radiation Therapy Center, during March 2006 to March 2011, were analyzed and followed up for vital status. Data were analyzed using the Kaplan-Meier method and the Cox proportional hazard models. RESULTS: Out of 532 patients, survival information was available for 460, including 205 (44/5%) females and 255 (55/4%) males. The mean age was 65.8±12.2, ranging from 29 to 90 years at the time of diagnosis. 1- , 3- and 5-year survival rates after diagnosis were 55%, 18% and 12%, respectively, with a median survival time of 13.2 ± .7 (CI 95%=11.8-14.6) months. In the univariate analysis, age (P=0/001), education (P=0/001), smoking status (P= 0/001), surgery (P=0/001), tumor differentiation (P=0/003) and tumor stage (P=0/001) were significant prognostic factors. Tumor morphology, sex, place of residence, tumor histology and tumor location did not show any significant effects on the survival rate. In multivariate analysis, age (P=0/003), smoking (P=0/01) and tumor stage (P=0/001) were significant independent predictors of survival. CONCLUSION: In summary, prognosis of esophageal cancer in North West of Iran is poor. Therefore, reduction in exposure to risk factors and early detection should be emphasized to improve survival.
