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101 Long-Term Survivors Who Had Metastatic Gastroesophageal Cancer and Received Local Consolidative Therapy

Authors
  • Mizrak Kaya, Dilsa
  • Wang, Xuemei
  • Harada, Kazuto
  • Blum Murphy, Mariela A.
  • Das, Prajnan
  • Minsky, Bruce D.
  • Estrella, Jeannelyn S.
  • Lin, Quan
  • Amlashi, Fatemeh G.
  • Lee, Jeffrey H.
  • Weston, Brian
  • Bhutani, Manoop S.
  • Matamoros Jr., Aurelio
  • Sagebiel, Tara
  • Wu, Carol C.
  • Rogers, Jane E.
  • Thomas, Irene
  • Maru, Dipen M.
  • Skinner, Heath D.
  • Badgwell, Brian D.
  • And 2 more
Type
Published Article
Journal
Oncology
Publisher
S. Karger AG
Publication Date
Jul 06, 2017
Volume
93
Issue
4
Pages
243–248
Identifiers
DOI: 10.1159/000475550
PMID: 28683449
Source
Karger
Keywords
License
Green
External links

Abstract

Background: Through a multidisciplinary decision-making process, we developed a strategy of systemic therapy followed by local consolidative therapy (chemoradiation with/without surgery) in selected patients with metastatic gastroesophageal carcinoma (mGEAC). Only after a consensus during multidisciplinary discussions, local therapy was initiated. Methods: We identified 101 patients with mGEAC who had local consolidation. We evaluated the association between various clinical variables (location of the primary, location of metastases, duration of initial chemotherapy, histologic grade, and radiation dose) and overall survival (OS). Results: Of 101 patients, 71 had a proximal primary (esophageal, Siewert type I or II), and 30 patients had a distal primary (Siewert type III or distal). The median OS was 25.7 months (95% confidence interval [CI] 22.3-32.8). The OS rates at 2 and 5 years were 53.8% (95% CI 44.7-64.8) and 20.7% (95% CI 13.4-31.9), respectively. OS was highly associated with the location of the primary (median of 22.8 months for Siewert I/II vs. 41.5 months for Siewert III or distal, p = 0.03). The duration of initial chemotherapy was highly associated with OS (median of 21.8 months for <3 months vs. 32.5 months for ≥3 months, p = 0.004). Conclusion: Some mGEAC patients with a favorable clinical course can achieve a ∼20% 5-year survival rate with an approach that uses initial chemotherapy followed by multidisciplinary discussion to proceed with consolidation with local therapy. Patients with distal GEAC and those who receive initial chemotherapy for ≥3 months are the maximum beneficiaries.

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