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        Palliative Radiotherapy in the Presence of Well-Controlled Metastatic Disease after Initial Chemotherapy May Prolong Survival in Patients with Metastatic Esophageal and Gastric Cancer

        Mohan Hingorani,Sanjay Dixit,Miriam Johnson,Victoria Plested,Kevin Alty,Peter Colley,Andrew W. Beavis,Rajarshi Roy,Anthony Maraveyas 대한암학회 2015 Cancer Research and Treatment Vol.47 No.4

        Purpose We report the outcomes of patients treated with palliative radiotherapy (pRT) to the primarytumour in the context of well-controlled metastatic disease after initial chemotherapy. Materials and MethodsClinical records of 132 patients with metastatic esophago-gastric (OG) cancer treated withpalliative chemotherapy (pCT) between January 2009 and June 2013 were reviewed. Ninetysevenpatients had responding or stable disease after 3 months of chemotherapy, of whom53 patients received pRT to the primary tumour after initial chemotherapy in the presenceof well-controlled metastatic disease (group A, pCT-RT). The remaining 44 patients weretreated with pCT alone (group B, pCT). Treatment-related outcomes were assessed in abovegroups including time to local progression (TTLP), progression-free and overall survival. ResultsThe median overall survival for patients treated with pRT after initial chemotherapy (groupA) was 23.3 months (95% confidence interval [CI], 17.70 to 28.89 months) and significantlyhigher than the 14 months (95% CI, 10.91 to 17.08 months) in patients treated with pCTalone (group B) (p < 0.001). The use of pCT-RT was an independent predictor of OS in multivariateanalysis. Local recurrence was observed in 12/53 of patients (23%) in group Acompared to 16/44 (36%) in group B. The median TTLP was significantly higher in patientsafter pCT-RT at 17.3 months (5.23 months to 44.50 months) compared to 8.3 months(range, 4.10 to 25.23 months) in patients treated with pCT alone (p=0.006). ConclusionThe possibility of pRT influencing systemic disease in advanced OG cancer has not beenreported, and results from the present study present strong arguments for investigation ofthis therapeutic strategy in a randomized trial.

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