Document Type : Research articles


1 1. Health Science University Regional Training and Research Hospital, Department of Radiation Oncology, Erzurum, 25050, Turkey 2. Department of Radiation Oncology, Faculty of Medicine, Selcuk University, Konya 42075 Turkey

2 1. Health Science University Regional Training and Research Hospital, Department of Medical Oncology, Erzurum, 25050, Turkey 2. Biruni university medical faculty hospital, ?stanbul, Turkey

3 Health Science University Regional Training and Research Hospital, Department of Radiation Oncology, Erzurum, 25050, Turkey

4 Regional Training and Research Hospital, Department of Surgical Oncology, Erzurum, 25050, turkey.

5 1. Health Science University, Regional Training and Research Hospital, Department of Radiation Oncology, Erzurum, Turkey 2. Department of Radiation Oncology, Faculty of Medicine, Akdeniz University, Antalya, Turkey

6 Tekirdag State Hospital, Tekirdag, Turkey


Background: Esophageal cancer (EC) is known as the most common cancer around the world. The evidence supports that preoperative chemoradiotherapy (CRT) improves resectability and survival in locally advanced EC patients.
Objectives: The current study aimed to evaluate the results of treatment in patients suffering from EC in an endemic region.
Methods: In this study, a total of 180 EC patients treated with curative radiotherapy (RT) were retrospectively evaluated. Primary tumor location, histopathological characteristics, tumor, nodes, and metastases (TNM) status, gender, age, treatment modalities, and survival period were also assessed. The effects of prognostic factors on the survival rate were evaluated using single variable analysis.
Results: The median time of follow-up was reported as 22.9 months (range: 6-115 months). After 1-, 3-, and 5-year follow-up, the rates of survival were calculated at 86.6%, 46.6%, and 32.5%, respectively. The present study was conducted on 77 (42.8%) male and 103 (57.2%) female patients (mean age: 60±12 years). In histopathological assessment, squamous cell carcinoma was the most frequent diagnosis (n=156; -86.6%). The clinical stages were reported as II in 36.6% (n=66), IIIa in 23.4% (n=42), IIIb in 15.5% (n=28), and IIIc in 24.5% (n=44) of the patients. In this study, 54 (25%) patients were treated with definitive RT, 33 patients (18.3%) with postoperative adjuvant CRT or RT, 59 patients (32.8%) with preoperative CRT or RT, and 43 patients (23.9%) with definitive CRT. The Eastern Cooperative Oncology Group (ECOG) performance status was observed to be ECOG 0 in 51 subjects (28.4%), ECOG 1 in 95 subjects (52.8%), and ECOG 2 in 34 subjects (18.8%). Moreover, 96 (53.4%) and 84 (46.6%) patients received conventional and conformal RT, respectively. The median time of overall survival (OS) was reported as 29 months. In univariate analysis, the T stage (P=0.041), N stage (P=0.033), TNM staging (P=0.00), and concomitant CRT (0.001) were prognostic factors affecting median OS time. Concomitant CRT (hazard ratio [HR]: 0.513; 95% CI: 0.337-0.779; P=0.002) and TNM stage (HR: 2.265; 95% CI: 1.409-3.641) were observed statistically significant as independent prognostic factors of mortality in multivariate analysis.
Conclusions: Long-term survival using combined-modality therapy was demonstrated in patients with locally advanced EC. Furthermore, based on the results of multivariate analysis, TNM stage and concomitant CRT were considered independent prognostic factors of mortality.


  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7-34. doi: 10.3322/caac.21551. [PubMed: 30620402].
  2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi: 10.3322/caac.21492. [PubMed: 30207593].
  3. Shridhar R, Imani-Shikhabadi R, Davis B, Streeter OA, Thomas CR Jr. Curative treatment of esophageal cancer; an evidenced based review. J Gastrointest Cancer. 2013;44(4):375-84. doi: 10.1007/s12029-013-9511-9. [PubMed: 23824628].
  4. Shridhar R, Almhanna K, Meredith KL, Biagioli MC, Chuong MD, Cruz A, et al. Radiation therapy and esophageal cancer. Cancer Control. 2013;20(2):97-110. doi: 10.1177/107327481302000203.
  5. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-86. doi: 10.1002/ijc.29210. [PubMed: 25220842].
  6. Koca T, Arslan D, Basaran H, Cerkesli AK, Tastekin D, Sezen D, et al. Dietary and demographical risk factors for oesophageal squamous cell carcinoma in the Eastern Anatolian region of Turkey where upper gastrointestinal cancers are endemic. Asian Pac J Cancer Prev. 2015;16(5):1913-7. doi: 10.7314/apjcp.2015.16.5.1913. [PubMed: 25773844].
  7. Mathieu LN, Kanarek NF, Tsai HL, Rudin CM, Brock MV. Age and sex differences in the incidence of esophageal adenocarcinoma: results from the surveillance, epidemiology, and end results (SEER) registry (1973-2008). Dis Esophagus. 2014;27(8):757-63. doi: 10.1111/dote.12147. [PubMed: 24118313].
  8. el-Serag HB. The epidemic of esophageal adenocarcinoma. Gastroenterol Clin North Am. 2002;31(2):421-40. doi: 10.1016/s0889-8553(02)00016-x. [PubMed: 12134611].
  9. Javle M, Ailawadhi S, Yang GY, Nwogu CE, Schiff MD, Nava HR. Palliation of malignant dysphagia in esophageal cancer: a literature-based review. J Support Oncol. 2006;4(8):365-73. [PubMed: 17004508].
  10. Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA Jr, Al-Sarraf M, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA. 1999;281(17):1623-7. doi: 10.1001/jama.281.17.1623. [PubMed: 10235156].
  11. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11-20. doi: 10.1056/NEJMoa055531. [PubMed: 16822992].
  12. Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345(10):725-30. doi: 10.1056/NEJMoa010187. [PubMed: 11547741].
  13. Fokas E, Rodel C. Definitive, preoperative, and palliative radiation therapy of esophageal cancer. Viszeralmedizin. 2015;31(5):347-53. doi: 10.1159/000440638. [PubMed: 26989391].
  14. Mariette C, Dahan L, Mornex F, Maillard E, Thomas PA, Meunier B, et al. Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol. 2014;32(23):2416-22. doi: 10.1200/JCO.2013.53.6532. [PubMed: 24982463].
  15. Gao XS, Qiao X, Wu F, Cao L, Meng X, Dong Z, et al. Pathological analysis of clinical target volume margin for radiotherapy in patients with esophageal and gastroesophageal junction carcinoma. Int J Radiat Oncol Biol Phys. 2007;67(2):389-96. doi: 10.1016/j.ijrobp.2006.09.015. [PubMed: 17236963].
  16. Xie SH, Lagergren J. The male predominance in esophageal adenocarcinoma. Clin Gastroenterol Hepatol. 2016;14(3):338-47.e1. doi: 10.1016/j.cgh.2015.10.005. [PubMed: 26484704].
  17. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69-90. doi: 10.3322/caac.20107. [PubMed: 21296855].
  18. Vizcaino AP, Moreno V, Lambert R, Parkin DM. Time trends incidence of both major histologic types of esophageal carcinomas in selected countries, 1973-1995. Int J Cancer. 2002;99(6):860-8. doi: 10.1002/ijc.10427. [PubMed: 12115489].
  19. Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996;335(7):462-7. doi: 10.1056/NEJM199608153350702. [PubMed: 8672151].
  20. Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med. 1997;337(3):161-7. doi: 10.1056/NEJM199707173370304. [PubMed: 9219702].
  21. Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol. 2001;19(2):305-13. doi: 10.1200/JCO.2001.19.2.305. [PubMed: 11208820].
  22. Minsky BD, Pajak TF, Ginsberg RJ, Pisansky TM, Martenson J, Komaki R, et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol. 2002;20(5):1167-74. doi: 10.1200/JCO.2002.20.5.1167. [PubMed: 11870157].
  23. van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074-84. doi: 10.1056/NEJMoa1112088. [PubMed: 22646630].