Prolonged radiotherapy duration may negatively affect outcomes in esophageal cancer
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Key takeaways:
- Overall, 41% of patients experienced radiotherapy interruptions.
- Radiotherapy duration longer than 45 days resulted in inferior DFS, and longer than 39 days led to higher risk for locoregional failure.
Prolonged radiotherapy duration appeared associated with inferior DFS among a cohort of patients with esophageal cancer, according to study results published in JAMA Network Open.
Findings additionally showed that women and those with race/ethnicity other than white appeared most likely to experience longer radiotherapy duration and interruptions.
Rationale and methodology
The unplanned, post-hoc, secondary analysis of three NCI-sponsored NRG Oncology prospective, multi-institutional, phase 3 randomized clinical trials included 509 patients (median age, 64 years; 82% men; 74% white) with nonmetastatic esophageal cancer previously treated with standard-dose chemoradiotherapy between 1986 and 2013.
Researchers used multivariable models to examine the association between radiotherapy duration and interruptions and local-regional failure, distant failure, DFS and OS. They assessed radiotherapy duration as a dichotomized variable and used an X-Tile software to choose a cut point and its median value as a cut point, as well as a continuous variable.
Median follow-up was 4.01 years.
Findings
Overall, more than half (53%) of patients had a median radiotherapy duration cut point of 39 days or less compared with less than half (47%) of patients who had a median cut point of more than 39 days. The researchers reported an X-Tile software cut point of 45 days or less in 88% of patients vs. more than 45 days in 12%.
Results showed 41% of patients experienced radiotherapy interruptions. Factors associated with longer radiotherapy duration and interruptions included female vs. male sex and other vs. white race and ethnicity.
Results of multivariable models showed an association of radiotherapy duration longer than 45 days with inferior DFS (HR = 1.34; 95% CI, 1.01-1.77). The results for OS did not reach statistical significance. Researchers also observed a higher risk for locoregional failure among those who underwent radiotherapy for longer than 39 days (HR = 1.32; 95% CI, 1.06-1.65).
An analysis of radiotherapy duration as a continuous variable showed an association between each 1-week increase in duration and DFS failure (HR = 1.14; 95% CI, 1.01-1.28). Researchers also reported an increase in the HR for locoregional failure that did not reach statistical significance.
Implications
The findings suggest radiotherapy interruptions should be minimized to optimize outcomes, the researchers wrote.
“As a practical recommendation, for a patient starting a course of 28 fractions of radiotherapy on a Monday, the goal should be to complete the treatment course by Friday of the sixth week,” they wrote. “Treatment interruptions should be minimized by using aggressive supportive care and interventions to reduce patient nonadherence. If interruptions occur, incorporating weekend and/or twice-daily treatments, if appropriate, could be considered to keep the treatment duration less than 40 days.”
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Hallemeier CL, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.8504.
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