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Outcome Results of the 1996-1999 Patterns of Care Survey of the National Practice for Patients Receiving Radiation Therapy for Carcinoma of the Esophagus

From the University of Maryland School of Medicine, Baltimore, MD; American College of Radiology; Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Community Medical Center, Toms River, NJ; Boston University Medical Center; Massachusetts General Hospital, Boston, MA; Cancer Center at St Agnes, Fresno, CA; Memorial Sloan-Kettering Cancer Center, New York, NY.

Address reprint requests to Mohan Suntharalingam, MD, Department of Radiation Oncology, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21230; e-mail: msuntha{at}umm.edu

PURPOSE: A Patterns of Care Study of patients treated from 1996 to 1999 evaluated the national practice for patients receiving radiation therapy for carcinoma of the esophagus in the United States.

METHODS: A national survey was conducted at 59 institutions in a stratified random sample selected from a master list of radiation therapy facilities throughout the United States. Patient, tumor, and treatment characteristics were evaluated. Multivariate comparisons of survival times were made using the Cox proportional hazards model.

RESULTS: Adenocarcinoma was diagnosed in 51% of patients and squamous cell carcinoma in 49% of patients. Sixteen percent of patients were clinical stage (CS) I (using the 1983 American Joint Committee on Cancer system), 39% were CS II, and 33% were CS III. Significant variables in the multivariate analysis of survival times included clinical stage, treatment approach, and facility size. Patients with CS III disease had a higher hazard risk of death as compared with CS I patients (hazard ratio [HR], 2.01; P = .001), whereas those treated with chemoradiotherapy followed by surgery (HR, 0.32; P < .0001) had a decreased risk of death compared with chemoradiotherapy-only patients. Patients at small centers had a higher risk of death (HR, 1.32; P = .03) compared with patients treated at larger facilities.

CONCLUSION: Concurrent chemoradiotherapy continued to be the most commonly utilized treatment approach during the time period studied. The observation that patients undergoing surgical resection following chemoradiation have a decreased HR or chance of death compared with other treatment schemes supports the need for a randomized trial comparing these strategies.

Supported by grant No. CA 65435 from the National Cancer Institute, National Institutes of Health.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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