Assessment of a collaborative treatment model for trimodal management of esophageal cancer - PubMed (original) (raw)
Assessment of a collaborative treatment model for trimodal management of esophageal cancer
Brooks V Udelsman et al. J Thorac Dis. 2023.
Abstract
Background: Patients with esophageal cancer often receive care in a collaborative (multi-institutional) treatment model as opposed to a single institutional model. The effect of a collaborative model on the quality of trimodality therapy and survival is unknown.
Methods: The National Cancer Database (NCDB) was used to identify patients receiving neoadjuvant chemoradiotherapy (CRT) followed by esophagectomy for esophageal cancer between 2012-2017. Patients who received neoadjuvant therapy and surgery at a single institution were compared to those that received collaborative treatment across multiple institutions. Outcomes included adherence to guideline recommended multiagent chemotherapy, receipt of 41.4-50.4 Gy of radiation, R0 resection, pathologic complete response (pCR), and 5-year survival. Sociodemographics, comorbidities, and tumor characteristics were assessed in bivariate and multivariable analysis.
Results: Among 8,396 patients identified, 39% received treatment at a single institution, while 61% received collaborative treatment. Median travel distance to the site of esophagectomy was two times greater for patients receiving collaborative treatment (30 vs. 15 miles; P<0.001). Patients in the collaborative cohort were less likely to receive guideline-recommended multiagent chemotherapy (85% vs. 96%; P<0.001) and 41.4-50.4 Gy of radiation (89% vs. 91%; P=0.01). R0 resection rates were similar (94.4% vs. 93.7%; P=0.17). Patients who received collaborative treatment had an increased rate of pCR (24% vs. 22%; P=0.02). Overall, 90-day and 5-year survival were 92.9% and 42.6% respectively and did not differ significantly between the two groups.
Conclusions: Collaborative trimodality treatment of esophageal cancer is a common and reasonable practice model, which may alleviate patient travel burden with only a modest impact on the quality of CRT, pCR, 90-day survival, and 5-year survival.
Keywords: Esophageal cancer; chemoradiotherapy (CRT); esophagectomy; neoadjuvant treatment; trimodality therapy.
2023 Journal of Thoracic Disease. All rights reserved.
Conflict of interest statement
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-346/coif). DJB was paid a stipend from Iovance to attend a panel discussion on cell-based therapy that was unrelated to this work. The other authors have no conflicts of interest to declare.
Figures
Figure 1
Cohort selection. NCDB, National Cancer Database; CRT, chemoradiotherapy.
Figure 2
Comparison of guideline recommended chemoradiotherapy, pCR, and 90-day mortality post-esophagectomy in patients receiving trimodal therapy for esophageal cancer between single center and collaborative (multi-institutional) treatment models. pCR, pathologic complete response.
Figure 3
Kaplan-Meier survival curve in patients with locally advanced esophageal cancer who receive all care at a single institution compared to those receiving collaborative care across multiple institutions overall (A) and stratified by clinical stage (B-D). CI, confidence interval.
Figure 4
Sensitivity analysis including only patients who received guideline recommended chemoradiotherapy both overall (A) and stratified by stage (B-D). CI, confidence interval.
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