Patterns of treatment and outcome in patients with unresectable or inoperable esophageal cancer: A real world data

Background: Esophageal cancer is the eighth most common cancer in the world with a high mortality rate. Surgery radiation and chemotherapy have been tried in various combinations to improve on the survival rates. Our study provides real world data from a South Asian country on patterns of treatment and outcome in patients with unresectable or inoperable esophageal cancer. Materials and Methods: This study is a retrospective analysis of all consecutive esophageal cancer patients with medically inoperable or unresectable disease and treated with conformal radical radiotherapy at a tertiary cancer center from January 2016 to December 2017. Data regarding patients age histology location pretreatment imaging disease stage treatment details compliance and response to treatment and status at last followup were retrieved from their file. Continuous and categorical variables were summarized by descriptive statistics. Results: A total of 100 esophageal cancer patients with a mean age of 60.24 years were included in the study. 60% of the patients were male and upper onethird was the most common site involved. Squamous cell carcinoma was reported in 83% of the patients. About 70% of the patients had a T3/T4 disease and 44% also had nodal metastasis. The radiation dose ranged from 45Gy 63Gy (median = 59.4Gy). Further 15% and 54% of the patients received neoadjuvant and concurrent chemotherapy respectively. Radiation compliance was seen in 90% of the patients. With a median follow-up of 7 months (range 3 58 months) 80% of the patients were alive with 32.22% having no evidence of disease. Distant metastases and loco regional failure was seen in 32.22% and 28% of the patients respectively. Conclusion: Our study showed that esophageal cancer is more common in elderly males. Adherence to a uniform treatment protocol using concurrent chemo radiation is difficult in clinical practice especially in resource constrained set up. Both distant metastases and loco regional failure continues to be a matter of concern. Further improvement in local control must be evaluated by either radiation dose escalation or novel combinations with chemotherapy and immunotherapy in large multi centric trial settings.