Primary Gross Tumor Volume Is An Important Prognostic Factor In Locally Advanced Esophageal Cancer Patients Treated With Trimodality Therapy

Purpose/Objective(s)This study investigated the impact of primary gross tumor volume (GTV) on clinical outcomes in patients receiving trimodality therapy for locally advanced esophageal cancer.Materials/MethodsBetween August 2002 and July 2012, a total of 67 patients treated for esophageal cancer with chemoradiation therapy followed by definitive esophagectomy were analyzed. The primary GTV contoured at the time of computed tomography simulation for radiation therapy planning was identified and recorded in cubic centimeters. Patients were staged using 2002 American Joint Committee on Cancer criteria. GTV-primary cutoff values were determined with receiver operating characteristic analysis and deemed to be significant when subsequent χ2 analysis demonstrated a difference in examined risk factors. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Cox proportional hazards model. Univariate and multivariate predictors of OS and PFS were calculated as continuous variables.ResultsThirty-five patients were node positive, and 32 were node negative. Fifty-seven patients had adenocarcinoma, and 10 had squamous cell carcinoma. The range of GTV-primary was 4.2-799.3 cc (median, 56.2 cc). GTV-primary >85 cc was the best predictor of 5-year local failure (33.3% or 8.7% if ≤85 cc, P = 0.0116). GTV-primary >46 cc correlated with an increased risk of 5-year distant failure (37.1% or 6.7% if ≤46 cc, P = 0.001532). There was a higher likelihood of gross residual disease at time of resection when GTV-primary was >87 cc (63.2% or 27.1% if ≤87 cc, P = 0.005924). Significant predictors of increasing primary GTVs were tumor length, number of pathologically malignant nodes (node number), and metastatic lymph node ratio (MLR; proportion of pathologically positive nodes/dissected nodes). Univariate predictors of 5-year OS included GTV-primary (P = 0.000481), node number (P = 0.01781), and MLR (P = 0.02453). GTV-primary was the only multivariate predictors of PFS (P = 0.001228) and OS (P = 0.002991) at 5 years.ConclusionsIn our analysis, primary GTV was the most important prognostic factor of local failure, distant failure, and survival in locally advanced esophageal cancer patients receiving trimodality therapy. Patients with primary GTV >85 cc had a higher risk of local recurrence. Primary GTV >46 cc was associated with a higher risk of distant failure. GTV-primary was the only significant multivariate predictor of OS. Tumor volume is a powerful prognosticator and should aid decisions on whether to intensify local therapy or pursue adjuvant systemic therapy. Purpose/Objective(s)This study investigated the impact of primary gross tumor volume (GTV) on clinical outcomes in patients receiving trimodality therapy for locally advanced esophageal cancer. This study investigated the impact of primary gross tumor volume (GTV) on clinical outcomes in patients receiving trimodality therapy for locally advanced esophageal cancer. Materials/MethodsBetween August 2002 and July 2012, a total of 67 patients treated for esophageal cancer with chemoradiation therapy followed by definitive esophagectomy were analyzed. The primary GTV contoured at the time of computed tomography simulation for radiation therapy planning was identified and recorded in cubic centimeters. Patients were staged using 2002 American Joint Committee on Cancer criteria. GTV-primary cutoff values were determined with receiver operating characteristic analysis and deemed to be significant when subsequent χ2 analysis demonstrated a difference in examined risk factors. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Cox proportional hazards model. Univariate and multivariate predictors of OS and PFS were calculated as continuous variables. Between August 2002 and July 2012, a total of 67 patients treated for esophageal cancer with chemoradiation therapy followed by definitive esophagectomy were analyzed. The primary GTV contoured at the time of computed tomography simulation for radiation therapy planning was identified and recorded in cubic centimeters. Patients were staged using 2002 American Joint Committee on Cancer criteria. GTV-primary cutoff values were determined with receiver operating characteristic analysis and deemed to be significant when subsequent χ2 analysis demonstrated a difference in examined risk factors. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Cox proportional hazards model. Univariate and multivariate predictors of OS and PFS were calculated as continuous variables. ResultsThirty-five patients were node positive, and 32 were node negative. Fifty-seven patients had adenocarcinoma, and 10 had squamous cell carcinoma. The range of GTV-primary was 4.2-799.3 cc (median, 56.2 cc). GTV-primary >85 cc was the best predictor of 5-year local failure (33.3% or 8.7% if ≤85 cc, P = 0.0116). GTV-primary >46 cc correlated with an increased risk of 5-year distant failure (37.1% or 6.7% if ≤46 cc, P = 0.001532). There was a higher likelihood of gross residual disease at time of resection when GTV-primary was >87 cc (63.2% or 27.1% if ≤87 cc, P = 0.005924). Significant predictors of increasing primary GTVs were tumor length, number of pathologically malignant nodes (node number), and metastatic lymph node ratio (MLR; proportion of pathologically positive nodes/dissected nodes). Univariate predictors of 5-year OS included GTV-primary (P = 0.000481), node number (P = 0.01781), and MLR (P = 0.02453). GTV-primary was the only multivariate predictors of PFS (P = 0.001228) and OS (P = 0.002991) at 5 years. Thirty-five patients were node positive, and 32 were node negative. Fifty-seven patients had adenocarcinoma, and 10 had squamous cell carcinoma. The range of GTV-primary was 4.2-799.3 cc (median, 56.2 cc). GTV-primary >85 cc was the best predictor of 5-year local failure (33.3% or 8.7% if ≤85 cc, P = 0.0116). GTV-primary >46 cc correlated with an increased risk of 5-year distant failure (37.1% or 6.7% if ≤46 cc, P = 0.001532). There was a higher likelihood of gross residual disease at time of resection when GTV-primary was >87 cc (63.2% or 27.1% if ≤87 cc, P = 0.005924). Significant predictors of increasing primary GTVs were tumor length, number of pathologically malignant nodes (node number), and metastatic lymph node ratio (MLR; proportion of pathologically positive nodes/dissected nodes). Univariate predictors of 5-year OS included GTV-primary (P = 0.000481), node number (P = 0.01781), and MLR (P = 0.02453). GTV-primary was the only multivariate predictors of PFS (P = 0.001228) and OS (P = 0.002991) at 5 years. ConclusionsIn our analysis, primary GTV was the most important prognostic factor of local failure, distant failure, and survival in locally advanced esophageal cancer patients receiving trimodality therapy. Patients with primary GTV >85 cc had a higher risk of local recurrence. Primary GTV >46 cc was associated with a higher risk of distant failure. GTV-primary was the only significant multivariate predictor of OS. Tumor volume is a powerful prognosticator and should aid decisions on whether to intensify local therapy or pursue adjuvant systemic therapy. In our analysis, primary GTV was the most important prognostic factor of local failure, distant failure, and survival in locally advanced esophageal cancer patients receiving trimodality therapy. Patients with primary GTV >85 cc had a higher risk of local recurrence. Primary GTV >46 cc was associated with a higher risk of distant failure. GTV-primary was the only significant multivariate predictor of OS. Tumor volume is a powerful prognosticator and should aid decisions on whether to intensify local therapy or pursue adjuvant systemic therapy.