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https://hdl.handle.net/2440/10587
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dc.contributor.author | Denham, J. | - |
dc.contributor.author | Steigler, A. | - |
dc.contributor.author | Kilmurray, J. | - |
dc.contributor.author | Wratten, C. | - |
dc.contributor.author | Burmeister, B. | - |
dc.contributor.author | Lamb, D. | - |
dc.contributor.author | Joseph, D. | - |
dc.contributor.author | Delaney, G. | - |
dc.contributor.author | Christie, D. | - |
dc.contributor.author | Jamieson, G. | - |
dc.contributor.author | Smithers, B. | - |
dc.contributor.author | Ackland, S. | - |
dc.contributor.author | Walpole, E. | - |
dc.date.issued | 2003 | - |
dc.identifier.citation | Clinical Oncology, 2003; 15(3):98-108 | - |
dc.identifier.issn | 0936-6555 | - |
dc.identifier.issn | 1433-2981 | - |
dc.identifier.uri | http://hdl.handle.net/2440/10587 | - |
dc.description.abstract | <h4>Aim</h4>The detailed review of patterns of failure in this report was undertaken to identify the continuing obstacles to the successful management of oesophageal cancer, and to establish whether there is a case to compare definitive chemo-radiation (Def-CR) and surgery for patients with squamous cancer in a randomized controlled trial.<h4>Materials and methods</h4>First and subsequent sites of failure were reviewed in 274 patients treated with Def-CR using two cycles of cisplatin, infusional fluorouracil and 60 Gy; and 92 patients with limited chemo-radiation (CR), using one cycle and 35 Gy, followed by surgery (CR-Surg). All were treated on prospective non-randomized trials run by the Trans-Tasman Radiation Oncology Group between 1985 and 1999. Failure patterns were analysed using competing risks methodology, and pre-treatment variables predicting survival were identified by proportional hazards modelling.<h4>Results</h4>Site, stage, performance status and gender were independently predictive of survival following Def-CR. Local failure was evident in 42.3% of patients, but distant failure in isolation occurred in an additional 18.1%. Lowest rates of local and distant failure at 5 years (29.9% and 26%) occurred in patients with squamous cancer (SCC) located in the upper-third, whose 5-year survival was also the most favourable (49.2%). Survival was least favourable in patients with adenocarcinoma (AC) in the lower two-thirds (18.1%) due to higher rates of local (51.5%) and distant (36.1%) failure. Local failure occurred in 31.5% of patients undergoing CR-Surg but distant failure in isolation was observed in a further 34.7%. Outcomes were least favourable in patients with AC of the lower-third in whom 57.7% failed distantly and 5-year survival was 3.8%. Response to pre-operative chemo-radiation was also strongly predictive of outcome. Patients with no residual cancer in the resection specimen had the lowest rates of local (0%) and distant (16.7%) failure and the best survival (64.9%). Survival in patients with residual cancer in nodes, however, was extremely poor (3.5%) with distant failure occurring in 66.7%.<h4>Conclusion</h4>The concurrent administration of chemotherapy with radiotherapy seems to have improved loco-regional control and has exposed distant failure as an obstacle to further improvements in outcome. Site, histological subtype, gender and response to chemo-radiation may predict biological differences in oesophageal cancer (OC) that influence outcome. A good case for a randomized comparison between Def-CR and CR-Surg in patients with SCC in the lower two-thirds exists. | - |
dc.description.statementofresponsibility | J.W. Denham, A. Steigler, J. Kilmurray, C. Wratten, B. Burmeister, D.S. Lamb, D. Joseph, G. Delaney, D. Christie, G. Jamieson, B.M. Smithers, S. Ackland and E. Walpole | - |
dc.language.iso | en | - |
dc.publisher | Elsevier Science London | - |
dc.rights | Copyright 2003 The Royal College of Radiologists. Published by Elsevier Science Ltd. All rights reserved | - |
dc.source.uri | http://dx.doi.org/10.1053/clon.2003.0212 | - |
dc.subject | Oesophageal cancer, Chemo-radiation, Patterns of failure, Metastases, Competing risks | - |
dc.title | Relapse patterns after chemo-radiation for carcinoma of the oesophagus | - |
dc.type | Journal article | - |
dc.identifier.doi | 10.1053/clon.2003.0212 | - |
pubs.publication-status | Published | - |
Appears in Collections: | Aurora harvest 7 Surgery publications |
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