CLINICOPATHOLOGICAL FACTORS AFFECTING SURVIVAL OUTCOMES OF ESOPHAGEAL CANCER PATIENTS TREATED AT A SINGLE TERTIARY RADIOTHERAPY CENTER IN IRAQ

Authors

  • Redeer Adnan Mikaeil Radiation Oncology, Zhianawa Cancer Center, Sulaimani, Kurdistan Region, Iraq.
  • Kamal Ahmad Saeed College of Medicine, University of Sulaimani. Kurdistan Region, Iraq.
  • Nyan Othman Saeed Radiation Oncology, Zhianawa Cancer Center, Sulaimani, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10410

Keywords:

Esophageal cancer, clinicopathological factors, radiotherapy, survival outcomes

Abstract

Background
Carcinoma of the oesophagus is one of the top ten most prevalent and aggressive types of cancer worldwide.


Objectives
To determine the clinicopathological factors affecting the survival of oesophagal cancer.


Patients and Methods
This cross-sectional study was conducted retrospectively on 97 patients with oesophagal cancer in a single radiotherapy cancer centre in Sulaimaniyah City, Kurdistan region of Iraq, from 2010 to 2021.


Results
The mean age of the patients was 68.4 ± 12.2, ranging from 29 to 90 years old. The major histology was squamous cell carcinoma (89%), and pathological grade II disease was more prevalent (53%). Males and females were equally affected (50% for each gender). At presentation, a larger number of the patients were located in the lower (N=30) and mid (N=29) oesophagus. Stage III was the most common presenting stage (45.7%). The median follow-up time was 14 months. The 12-month and 18-month survival rates were 58.6% and 34.6%, respectively. There was a significantly better survival outcome for patients with grade 1 disease than higher grades, especially grade 2 (p value= 0.01). Chemoradiation showed significantly improved survival benefits compared with RT alone (p value= 0.03) and tri-modality therapy.


Conclusion
The most significant factors affecting 18-month actual survival in oesophagal cancer are tumour biology characteristics, especially low tumour grade, and chemoradiotherapy without surgery.

References

Torre LA; Bray F; Siegel RL; Ferlay J; Lortet-Tieulent J; Jemal A; Global cancer statistics, 2012 [Internet]. CA: a cancer journal for clinicians. U.S. National Library of Medicine; [cited 2022 Oct18]. Available from: https://pubmed.ncbi.nlm.nih.gov/25651787/

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018, 68:394-424. 10.3322/caac.21492 DOI: https://doi.org/10.3322/caac.21492

Pohl H, Sirovich B, Welch HG: Esophageal adenocarcinoma incidence: Are we reaching the peak? Cancer Epidemiol Biomarkers Prev. 2010, 19:1468-70. 10.1158/1055-9965.EPI-10-0012 DOI: https://doi.org/10.1158/1055-9965.EPI-10-0012

Brown LM, Devesa S S, Chow W H. Incidence of adenocarcinoma of the oesophagus among white Americans by sex, stage, and age. J Natl Cancer Inst. 2008; 100 (16): 1184–7. DOI: https://doi.org/10.1093/jnci/djn211

Gholipour C, Shalchi R A, Abbasi M. A histopathological study of oesophagal cancer on the western side of the Caspian littoral from 1994 to 2003. This Esophagus. 2008; 21 (4): 322–7. DOI: https://doi.org/10.1111/j.1442-2050.2007.00776.x

Löfdahl HE; Lane A; Lu Y; Lagergren P; Harvey RF; Blazeby JM; Lagergren J; Increased population prevalence of reflux and obesity in the United Kingdom compared with Sweden: A potential explanation for the difference in the incidence of oesophagal adenocarcinoma [Internet]. European Journal of Gastroenterology & Hepatology. U.S. National Library of Medicine; [cited 2022 Oct18]. Available from: https://pubmed.ncbi.nlm.nih.gov/21178778/

Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003; 349:2241-52. DOI: https://doi.org/10.1056/NEJMra035010

Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the oesophagus. N Engl J Med. 1997; 337:161-7. DOI: https://doi.org/10.1056/NEJM199707173370304

Tepper J, Krasna MJ, Niedzwiecki D, Hollis D, Reed CE, Goldberg R, et al. Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for oesophagal cancer: CALGB 9781. J ClinOncol. 2008; 26:1086-92. DOI: https://doi.org/10.1200/JCO.2007.12.9593

Ajani JA; D'Amico TA; Bentrem DJ; Chao J; Corvera C; Das P; et al. Esophageal and Esophagogastric junction cancers, version 2.2019, NCCN clinical practice guidelines in oncology [Internet]. Journal of the National Comprehensive Cancer Network: JNCCN. U.S. National Library of Medicine. Available from: https://pubmed.ncbi.nlm.nih.gov/31319389/

Van Hagen P; Hulshof MC; van Lanschot JJ; Steyerberg EW; van Berge Henegouwen MI; Wijnhoven BP; et at. Preoperative chemoradiotherapy for oesophagal or junctional cancer [Internet]. The New England Journal of Medicine. U.S. National Library of Medicine. Available from: https://pubmed.ncbi.nlm.nih.gov/22646630/

Stahl M;Stuschke M;Lehmann N;Meyer HJ;Walz MK;Seeber S et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the oesophagus [Internet]. Journal of clinical oncology: Official American Society of Clinical Oncology journal. U.S. National Library of Medicine. Available from: https://pubmed.ncbi.nlm.nih.gov/15800321/.

Bedenne L, Michel P, Bouché O, Milan C, Mariette C, Conroy T, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the oesophagus: FFCD 9102. Journal of Clinical Oncology. 2007;25(10):1160–8. DOI: https://doi.org/10.1200/JCO.2005.04.7118

Suntharalingam M, Moughan J, Coia LR, Krasna MJ, Kachnic L, Haller DG, et al. Outcome results of the 1996-1999 Patterns of Care survey of the national practice for patients receiving radiation therapy for carcinoma of the oesophagus. Journal of Clinical Oncology. 2005;23(10):2325–31. DOI: https://doi.org/10.1200/JCO.2005.00.448

Smith GL, Smith BD, Buchholz TA, Liao Z, Jeter M, Swisher SG, et al. Patterns of care and loco-regional treatment outcomes in older oesophagal cancer patients: THE SEER-medicare cohort. International Journal of Radiation Oncology*Biology*Physics. 2009;74(2):482–9. DOI: https://doi.org/10.1016/j.ijrobp.2008.08.046

National Comprehensive Cancer Network - Home [Internet]. NCCN. [cited 2022Oct18]. Available from: http://nccn.org/

vanBlankenstein M, Looman CW, Siersema PD, Kuipers EJ, Coebergh JW. Trends in the incidence of adenocarcinoma of the oesophagus and cardia in the Netherlands 1989–2003. Br J Cancer. 2007; 96:1767–71. DOI: https://doi.org/10.1038/sj.bjc.6603798

Guardino JM, Khandwala F, Lopez R, Wachsberger DM, Richter JE, Falk GW. Barrett's oesophagus at a tertiary care centre: association of age on incidence and prevalence of dysplasia and adenocarcinoma. Am J Gastroenterol. 2006; 101:2187–93. DOI: https://doi.org/10.1111/j.1572-0241.2006.00736.x

Gavin AT, Francisci S, Foschi R, Donnelly DW, Lemmens V, Brenner H, et al. Oesophageal cancer survival in Europe: A EUROCARE-4 study. Cancer Epidemiol. 2012; 36:505–12. DOI: https://doi.org/10.1016/j.canep.2012.07.009

Wo JY, Hong TS, Kachnic LA. Impact of age and co-morbidities on the treatment of gastrointestinal malignancies. SeminRadiatOncol. 2012; 22:311–20. DOI: https://doi.org/10.1016/j.semradonc.2012.05.008

Micheli A, Ciampichini R, Oberaigner W, Ciccolallo L, de Vries E, Izarzugaza I, et al. The advantage of women in cancer survival: an analysis of EUROCARE-4 data. Eur J Cancer. 2009; 45:1017–27. DOI: https://doi.org/10.1016/j.ejca.2008.11.008

Hur C, Miller M, Kong CY, Dowling EC, Nattinger KJ, Dunn M, et al. Trends in oesophagal adenocarcinoma incidence and mortality. Cancer. 2012;119(6):1149–58. DOI: https://doi.org/10.1002/cncr.27834

Bashash M, Hislop T G, Shah A M, Le N, Brooks-Wilson A, Bajdik C D. The prognostic effect of ethnicity for gastric and oesophagal cancer: the population-based experience in British Columbia, Canada. BMC Cancer 2011; 11: 164. DOI: https://doi.org/10.1186/1471-2407-11-164

Zhang H Z, Jin G F, Shen H B. Epidemiologic differences in oesophagal cancer between Asian and Western populations. Chin J Cancer 2012; 31 (6): 281–6. DOI: https://doi.org/10.5732/cjc.011.10390

Kim T; Grobmyer SR; Smith R; Ben-David K; Ang D; Vogel SB; Hochwald SN; Esophageal cancer--the five-year survivors [Internet]. Journal of surgical oncology. U.S. National Library of Medicine; [cited 2022 Oct18]. Available from: https://pubmed.ncbi.nlm.nih.gov/21259254/

Price EL, Etienne PL, Meunier B, Maddern G, Hassel MB, Gedouin D, et al. A randomised study of chemotherapy, radiation therapy, and surgery versus surgery for localised squamous cell carcinoma of the oesophagus. Cancer. 1994;73(7):1779–84. DOI: https://doi.org/10.1002/1097-0142(19940401)73:7<1779::AID-CNCR2820730702>3.0.CO;2-T

Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomised trial of preoperative chemoradiation versus surgery alone in patients with Loco-regional oesophagal carcinoma. Journal of Clinical Oncology. 2001;19(2):305–13. DOI: https://doi.org/10.1200/JCO.2001.19.2.305

Burmeister BH, Smithers BM, Gebski V, Fitzgerald L, Simes RJ, Devitt P, et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable oesophagus cancer: A randomised controlled phase iii trial. The Lancet Oncology. 2005;6(9):659–68. DOI: https://doi.org/10.1016/S1470-2045(05)70288-6

Shapiro J, van Lanschot JJ, Hulshof MC, van Hagen P, van Berge Henegouwen MI, Wijnhoven BP, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (cross): Long-term randomised controlled trial results. The Lancet Oncology. 2015;16(9):1090–8. DOI: https://doi.org/10.1016/S1470-2045(15)00040-6

Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJH, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. New England Journal of Medicine. 2006;355(1):11–20. DOI: https://doi.org/10.1056/NEJMoa055531

Ychou M, Boige V, Pignon J-P, Conroy T, Bouché O, Lebreton G, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: An FNCLCC and FFCD multicenter phase III trial. Journal of Clinical Oncology. 2011;29(13):1715–21. DOI: https://doi.org/10.1200/JCO.2010.33.0597

Ji KSY, Thomas SM, Roman SA, Czito B, Anderson KL Jr, Frakes J, et al. Low- vs high-dose neoadjuvant radiation in trimodality treatment of locally advanced oesophagal cancer. J Gastrointest Surg. (2019) 23:885–94. doi: 10.1007/s11605-018-4007-3 DOI: https://doi.org/10.1007/s11605-018-4007-3

Haque W, Verma V, Butler EB, Teh BS. Radiation dose in neoadjuvant chemoradiation therapy for oesophagal cancer: patterns of care and outcomes from the National Cancer Data Base. J GastrointestOncol. (2018) 9:80–9. doi: 10.21037/jgo.2017.09.12 DOI: https://doi.org/10.21037/jgo.2017.09.12

Semenkovich TR, Samson PP, Hudson JL, Subramanian M, Meyers BF, Kozower BD, et al. Induction radiation therapy for oesophagal cancer: Does dose affect outcomes? Ann Thorac Surg. (2019) 107:903–11. doi: 10.1016/j.athoracsur.2018.09.064 DOI: https://doi.org/10.1016/j.athoracsur.2018.09.064

Worrell SG, Towe CW, Dorth JA, Machtay M, Perry Y, Linden PA. Higher doses of neoadjuvant radiation for oesophagal cancer do not affect the pathologic complete response rate or survival: a propensity-matched analysis. Ann SurgOncol. (2020) 27:500–8. doi: 10.1245/s10434-019-07849-z DOI: https://doi.org/10.1245/s10434-019-07849-z

Otterstatter MC, Brierley JD, De P, Ellison LF, MacIntyre M, Marrett LD, et al. Oesophagal cancer in Canada: Trends according to morphology and anatomical location. Canadian Journal of Gastroenterology. 2012;26(10):723–7. DOI: https://doi.org/10.1155/2012/649108

Doki Y, Ishikawa O, Takachi K, Miyashiro I, Sasaki Y, Ohigashi H, et al. Association of the primary tumour location with the site of tumour recurrence after curative resection of thoracic oesophagal carcinoma. World Journal of Surgery. 2005;29(6):700–7. DOI: https://doi.org/10.1007/s00268-005-7596-4

Published

2023-06-21

How to Cite

1.
Mikaeil R, Saeed K, Saeed N. CLINICOPATHOLOGICAL FACTORS AFFECTING SURVIVAL OUTCOMES OF ESOPHAGEAL CANCER PATIENTS TREATED AT A SINGLE TERTIARY RADIOTHERAPY CENTER IN IRAQ. JSMC [Internet]. 2023 Jun. 21 [cited 2024 Jun. 27];13(2):10. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10410

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