Surgically treated oesophageal cancer developed in a radiated field: Impact on peri-operative and long-term outcomes

• Published in: European journal of cancer (1990) Vol. 75; pp. 179 - 189
• Main Authors: Markar, Sheraz R, Gronnier, Caroline, Pasquer, Arnaud, Duhamel, Alain, Behal, Hélène, Théreaux, Jérémie, Gagnière, Johan, Lebreton, Gil, Brigand, Cécile, Meunier, Bernard, Collet, Denis, Mariette, Christophe
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-04-2017; Elsevier Science Ltd; Elsevier
• Subjects: Adenocarcinoma - etiology; Adenocarcinoma - mortality; Adenocarcinoma - surgery; Aged; Background radiation; Breast cancer; Cancer; Carcinogenesis; Carcinogens; Carcinoma, Squamous Cell - etiology; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - surgery; Chemoradiotherapy; Chemotherapy; Confidence intervals; Esophageal cancer; Esophageal Neoplasms - etiology; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; Esophagus; Female; Hematology, Oncology and Palliative Medicine; Hospital Mortality; Human health and pathology; Humans; Incidence; Life Sciences; Male; Matching; Middle Aged; Morbidity; Neoplasms, Radiation-Induced - etiology; Neoplasms, Radiation-Induced - mortality; Neoplasms, Radiation-Induced - surgery; Neoplasms, Second Primary - etiology; Neoplasms, Second Primary - mortality; Neoplasms, Second Primary - surgery; Oesophageal cancer; Patients; Postoperative Complications - etiology; Postoperative Complications - mortality; Radiation therapy; Radiotherapy - adverse effects; Radiotherapy-induced neoplasm; Second primary malignancy; Surgery; Survival; Treatment Outcome; Tumors; Second primary malignancy; Oesophageal cancer; Radiotherapy-induced neoplasm; Breast cancer; Survival
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2016.12.036

Abstract Background The objectives of this study were to compare peri-operative and long-term outcomes from oesophageal cancer (EC) (i) that arose in a previously radiated field (ECRF) versus primary (PEC) and among ECRF patients and (ii) radiotherapy-induced (RIEC) versus non-radiotherapy–induced EC (NRIEC). Methods Data were collected from 30 European centres from 2000 to 2010. Two thousand four hundred eighty nine EC patients surgically treated were included in the PEC group and 136 in the ECRF group, NRIEC group (n = 61) and RIEC group (n = 75). Propensity score matching analyses were used to compensate for differences in baseline characteristics. Results Compared to the PEC group, the ECRF group was characterised by less use of neoadjuvant chemoradiotherapy (0% versus 29.5%; P < 0.001), less pathological stage III/IV (31.6% versus 39.2%, P = 0.036), greater incidence of R1/2 margins (21.3% versus 10.9%; P < 0.001), increased in-hospital mortality (14.0% versus 7.1%; P = 0.003) and overall morbidity (68.4% versus 56.4%, P = 0.006). After matching, 5-year overall (28.8% versus 50.5%; hazard ratio [HR] = 1.53, 95% confidence interval [CI]: 1.15–2.04; P = 0.003) and event-free (32.2% versus 42.5%; HR = 1.56, 95% CI: 1.18–2.05; P = 0.002) survivals were significantly reduced in the ECRF group. There were no significant differences in incidence or pattern of tumour recurrence. Comparing RIEC and NRIEC groups, there were no significant differences in short- or long-term outcomes before and after matching. Conclusions ECRF is associated with poorer long-term survival related to a reduced utilisation of neoadjuvant chemoradiotherapy and an increased incidence of tumour margin involvement at surgery. Outcomes appear to be dictated by the limitations related to previous radiotherapy administration more than the radiotherapy-induced carcinogenesis.