Outcomes with esophageal cancer radiation therapy.

PURPOSE Esophageal cancer is the seventh leading cause of cancer death worldwide and is responsible for 4% of the cancer deaths in the United States annually. Changing epidemiologic patterns and expanded treatment options have brought this often deadly cancer to the forefront. METHODS AND MATERIALS To characterize epidemiological changes, the effect of treatment advances, and patient outcomes over time, we retrospectively reviewed 756 consecutive esophageal cancer cases treated between 1985 to 2003 at The University of Texas M. D. Anderson Cancer Center in Houston. For purposes of evaluation, cases were divided into four cohorts of approximately 5 years each. Men make up 75% or more of the patients with esophageal cancer, most patients have adenocarcinoma in the gastroesophageal junction, and almost 75% have stage II or III disease. RESULTS Three-year overall survival improved from 16.7% (1985-1989) to 35.2% (2000-2003). By multivariate Cox regression analysis, significant reductions in relative risk were associated with having good performance status (relative risk [RR] = 0.68 [95% confidence interval (CI) = 0.56-0.83]; p < 0.001), being treated in the most recent interval (2000-2003) than in the first (1985-1989) (RR = 0.63 [95% CI = 0.44-0.88]; p = 0.007), with improved therapies, including induction chemotherapy plus concurrent chemoradiotherapy (RR = 0.68 [CI = 0.56-0.84]; p < 0.001), explaining the reductions. CONCLUSION Although fully delineated comparisons must await incorporation and study of data through 2007, this analysis suggests that multimodality management that has been adapted in recent years may be associated with the improvements in outcomes of these cases of largely stage II and III esophageal adenocarcinoma found at the gastroesophageal junction.