How appropriate is treating patients diagnosed with advanced esophageal cancer with anticancer drugs? A multicenter retrospective cohort Spanish study.

AIM: To assess the appropriateness of systemic oncological treatments (SOT) provided to patients diagnosed with advanced esophageal cancer (EC) across a group of participating hospitals. METHODS: Multicenter, retrospective cohort study in five Spanish hospitals including newly confirmed advanced EC cases between July 1, 2014, and June 30, 2016, with a 5-year follow-up. RESULTS: We identified 157 patients fulfilling the inclusion criteria (median age: 65 years, 85.9% males). Most patients, 125 (79.6%) were treated at least with one active treatment, and 33% received two or more lines of SOT. The 1-, 2- and 5-year overall survival rates were 30.3% [95%CI: 23.8, 38.7], 14.0% [95%CI: 9.3, 21.0], and 7.1% [95% CI: 3.8, 13.1] respectively, and the median survival time 8 months (95% CI: 6, 19) for stages IIIb IIIc and 7 months (95% CI: 5, 9) for stage IV. Clinical stage, receiving more than one line of SOT, and treatment with radiotherapy accelerated the time to death (0.4, 0.9-, and 0.8-times shorter survival respectively, p < 0.05). Better performance status (ECOG < 2) extended survival time by 2.2 times (p = 0.04). Age < 65 years (OR 9.4, 95% CI 3.2, 31.4, p < 0.001), and being treated in one particular hospital (OR 0.2, 95% CI 0.0, 0.8, p < 0.01) were associated with the administration of two or more lines of SOT. Altogether, 18.9% and 9.0% of patients received chemotherapy in the last four and two weeks of life, respectively. Moreover, 2.5% of patients were prescribed a new line of chemotherapy during the last month of life. The proportion of all patients who did not have access to palliative care reached 29.3%, and among those who had access to it, 34.2% initiated it in the last month of life. CONCLUSION: A high proportion of advanced EC patients receive many treatments not based on sound evidence and they do not benefit enough from palliative care services. The most accepted appropriateness indicators point out that some of the analyzed patients could have been overtreated. This study provides important insights into the quality of care provided to advanced EC, and furthermore, for giving valuable insight and opportunities for improvement.

Caracterización clínico-patológica de pacientes con cáncer esofágico avanzado en el Hospital Princess Marina, Botsuana / Clinicopathological characterization of patients with advanced esophageal cancer at Princess Marina Hospital, Botswana / Caracterização clínico-patológica de pacientes com câncer de esôfago avançado no Hospital Princess Marina, Botswana

RESUMEN Introducción: El cáncer de esófago avanzado es una de las neoplasias más agresivas con una elevada morbilidad y mortalidad. Botsuana ocupa el duodécimo cuarto puesto mundial con respecto a las muertes ocasionadas por esta enfermedad. Objetivo: Determinar las características clínico-patológicas de los pacientes con cáncer esofágico avanzado en el Hospital Princess Marina de Gaborone, Botsuana. Método: Se realizó un estudio prospectivo-descriptivo donde se caracterizó clínica y patológicamente a 45 pacientes con el diagnóstico endoscópico e histológico de cáncer de esófago avanzado en el periodo de enero a septiembre de 2019. Resultados: Predominó el sexo masculino (86,7 %) y los pacientes mayores de 60 años (60,0 %). La disfagia, la anorexia y la pérdida de peso fueron los síntomas más frecuentes y prevalecieron los pacientes con un tiempo entre la aparición de los síntomas y el diagnóstico-endoscópico entre tres y seis meses; la dieta inadecuada, el etilismo crónico y el hábito de fumar fueron los factores de riesgo predominantes. La localización anatómica más frecuente fue el tercio medio (51,1 %), el tipo endoscópico predominante fue el vegetante (46,7 %) y la mayoría de los pacientes presentó el tipo histológico carcinoma epidermoide (95,6 %) bien diferenciado (84,4 %). Conclusiones: El estudio de las características clínico-patológicas de los pacientes con cáncer esofágico avanzado permite su correcta estadificación, siendo una herramienta útil en la valoración multidisciplinaria del tratamiento debido a su complejo manejo clínico e institucional.

ABSTRACT Introduction: Advanced esophageal cancer is one of the most aggressive neoplasms with high morbidity and mortality. Botswana ranks 14th in the world for deaths from this disease. Objective: To determine the clinicopathological characteristics of patients with advanced esophageal cancer at the Princess Marina Hospital in Gaborone, Botswana. Method: A prospective-descriptive study was carried out, where 45 patients with endoscopic and histological diagnosis of advanced esophageal cancer were characterized clinically and pathologically, from January to September 2019. Results: Males predominated (86.7%), and also patients older than 60 years (60.0%). Dysphagia, anorexia and weight loss were the most frequent symptoms, and prevailed patients with three to six months between the appearance of symptoms and endoscopic diagnosis; inadequate diet, chronic alcoholism, and smoking were the predominant risk factors. The most frequent anatomical location was the middle third (51.1%), the predominant endoscopic type was the vegetative (46.7%) and most of the patients presented the histological type squamous cell carcinoma (95.6%) well differentiated (84.4%). Conclusions: The study of the clinical-pathological characteristics of patients with advanced esophageal cancer allows its correct staging, being a useful tool in the multidisciplinary assessment of treatment due to its complex clinical and institutional management.

RESUMO Introdução: O câncer de esôfago avançado é uma das neoplasias mais agressivas com alta morbimortalidade. Botswana ocupa o 14º lugar no mundo em mortes por esta doença. Objetivo: determinar as características clínico-patológicas de pacientes com câncer de esôfago avançado no Hospital Princesa Marina em Gaborone, Botsuana. Método: Foi realizado estudo prospectivo-descritivo em que 45 pacientes com diagnóstico endoscópico e histológico de câncer de esôfago avançado foram caracterizados clínica e patologicamente de janeiro a setembro de 2019. Resultados: Predominou o sexo masculino (86,7%) e pacientes com mais de 60 anos ( 60,0%). Disfagia, anorexia e perda de peso foram os sintomas mais frequentes e prevaleceram os pacientes com tempo entre o aparecimento dos sintomas e o diagnóstico endoscópico entre três e seis meses; dieta inadequada, alcoolismo crônico e tabagismo foram os fatores de risco predominantes. A localização anatômica mais frequente foi o terço médio (51,1%), o tipo endoscópico predominante foi o vegetativo (46,7%) e a maioria dos pacientes apresentou o tipo histológico carcinoma espinocelular (95,6%) bem diferenciado (84,4%). Conclusões: O estudo das características clínico-patológicas dos pacientes com câncer de esôfago avançado permite seu correto estadiamento, sendo uma ferramenta útil na avaliação multidisciplinar do tratamento devido ao seu complexo manejo clínico e institucional.

Nimotuzumab combinado con quimioradioterapia en pacientes con carcinoma epidermoide esofágico avanzado en el mundo real / Nimotuzumab combined with chemoradiotherapy in patients with advanced esophageal squamous cell carcinoma in the real world

Introducción: La supervivencia global de pacientes con cáncer de esófago continúa siendo baja a pesar de los avances terapéuticos realizados en las últimas décadas. Objetivo: Evaluar respuesta al tratamiento y supervivencia global. Métodos: Se realizó un estudio retrospectivo y observacional en pacientes con carcinoma epidermoide esofágico avanzado, tratados con nimotuzumab combinado con quimioradioterapia, atendidos en el Servicio de Oncología Clínica del Hospital Ameijeiras, entre enero 2013 y junio de 2019 (n = 94). Se utilizó chi-cuadrado para la asociación de variables, con un valor p< 0,05. Se evaluó supervivencia global por el método de Kaplan Meier, y la prueba de Log-Rank para la comparación de las curvas. Resultados: La tasa de respuesta objetiva y de control de enfermedad fue 64,9 por ciento y 83 por ciento, respectivamente. El esquema de quimioterapia con cisplatino/fluouracilo fue el empleado con más frecuencia. Las variables con mayor respuesta y significación estadística fueron: ECOG cero, color de piel no blanca, tratamiento radiante ≥ 50 Gy, y más de catorce dosis de nimotuzumab. La mediana de supervivencia fue 13,03 meses (IC95 por ciento -10,9; 15,2), y las variables asociadas a una mayor probabilidad de supervivencia fueron: ECOG cero, dosis de quimioterapia > 75 por ciento de lo planificado, tratamiento radiante ≥ 50 Gy, más de catorce dosis de nimotuzumab, y alcanzar una respuesta objetiva (p< 0,05). Solo 5,8 por ciento de los pacientes presentaron toxicidades clasificadas como grado 3-5. Conclusiones: En condiciones de práctica clínica, este esquema de combinación obtuvo óptimas tasas de respuesta objetiva y supervivencia con buen perfil de toxicidad(AU)

Introduction: Overall survival of esophageal cancer patients remains low despite the therapeutic advances achieved in the last decades. Objective: Evaluate response to treatment and overall survival. Methods: An observational retrospective study was conducted of patients with advanced esophageal squamous cell carcinoma treated with nimotuzumab combined with chemoradiotherapy at the Clinical Oncology Service of Ameijeiras Hospital from January 2013 to June 2019 (n = 94). Association of variables was analyzed with the chi-square test, using a value of p < 0.05. Overall survival was evaluated with the Kaplan-Meier method, whereas the Log-Rank test was used to compare the curves. Results: Objective response and disease control rates were 64.9 percent and 83 percent, respectively. The chemotherapy scheme with cisplatin / fluorouracil was the most commonly applied. The variables with the greatest response and statistical significance were ECOG zero, skin color not white, radiation therapy ≥ 50 Gy and more than 14 doses of nimotuzumab. Median survival was 13.03 months (CI 95 percent -10,9; 15,2), whereas the variables associated to a greater probability of survival were ECOG zero, chemotherapy dose > 75% of plan, radiation therapy ≥ 50 Gy, more than 14 doses of nimotuzumab, and achieving an objective response (p< 0.05). Only 5.8 percent of the patients presented toxicities classified as grades 3-5. Conclusions: In clinical practice conditions, this combination scheme achieved optimum objective response and survival rates with a good toxicity profile(AU)