Recursive Partitioning Analysis Identifies Pretreatment Risk Groups for the Utility of Induction Chemotherapy prior to Definitive Chemoradiotherapy in Esophageal Cancer

Publication date: Available online 6 June 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Mian Xi, Zhongxing Liao, Weiye Deng, Ritsuko Komaki, Linus Ho, Steven H. Lin
PurposeTo assess the contribution of induction chemotherapy (IC) prior to definitive chemoradiotherapy (dCRT) in patients with esophageal cancer (EC) based on recursive partitioning analysis (RPA).Methods and MaterialsA total of 496 eligible EC with positron emission tomography (PET) who received dCRT from 1998 to 2015 were included, 162 (32.7%) of whom underwent IC before dCRT. RPA was used to risk-stratify patients on the basis of independent prognostic factors to predict progression-free survival (PFS). Outcomes were compared between treatment groups.ResultsMedian follow-up was 49.1 months (range, 7.0–155.9 months) for survivors. Compared with the non-IC group, the IC group had comparable 5-year PFS rate (21.0% vs. 23.4%; P = 0.726) in the whole cohort. Multivariate analysis identified age, performance status, primary tumor length, baseline PET SUVmax, and maximum lymph node diameter as independent prognostic factors for PFS. RPA segregated patients into three prognostic groups: low-risk (PET SUVmax <9.7 and tumor length ≤5 cm), intermediate-risk (PET SUVmax ≥9.7 and age ≥67), and high-risk group (PET SUVmax <9.7 and tumor length >5 cm; or PET SUVmax ≥9.7 and age <67). Significant improvements in PFS (P = 0.006) and locoregional failure-free survival (P = 0.028) in the IC group in comparison to the non-IC group were observed in high-risk patients, whereas no differences in survival were found between the two treatment groups in low- or intermediate-risk patients. After propensity score-matching, the high-risk group still demonstrated a significantly improved PFS with IC (P = 0.009).ConclusionsThe RPA prognostic grouping provides a useful method of selecting high-risk EC patients who may benefit from IC prior to dCRT. Prospective investigation is warranted.

Teaser

This study aimed to assess the contribution of induction chemotherapy (IC) prior to definitive chemoradiotherapy in patients with esophageal cancer based on recursive partitioning analysis (RPA). The results indicate that the addition of IC significantly improves progression-free survival in high-risk patients. However, no clear survival benefits were found in low- or intermediate-risk patients. Therefore, the RPA prognostic grouping could provide a useful method of selecting high-risk patients who may benefit from IC.


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