Discussion
esophageal cancer, cancer
ESOPHAGEAL CANCER, OESOPHAGEAL CANCER, CANCER, SECONDARY, ONCOLOGY
In this secondary analysis of patients with esophageal cancer treated with definitive CRT in NRG Oncology trials, the frequency of RT interruptions and the length of RT duration were characterized. The association between RT interruptions and RT duration and outcomes, including LRF, DFS, and OS, was examined. Key findings were (1) RT interruptions were common, occurring in 41% of patients; (2) RT interruptions and prolonged RT duration were more common in female than male patients and in those with other vs White race and ethnicity; and (3) RT interruptions and prolonged RT duration were associated with worse LRF and DFS in several models, supporting the hypothesis of correlation with inferior outcomes.There are few published reports evaluating the effect of RT interruptions and duration on outcomes for patients receiving definitive RT or CRT for esophageal cancer. In patients with localized esophageal cancer treated with RT alone (without chemotherapy), a meta-analysis of 11 randomized clinical trials conducted in mainland China found improved local control and survival following late-course accelerated, hyperfractionated RT regimens that delivered 60 to 70 Gy in 5 to 6 weeks compared with standard regimens delivering 60 to 70 Gy in 6 to 7 weeks.In the context of the COVID-19 pandemic, patients and oncologists have faced substantial uncertainty and challenging decisions, including consideration of cancer treatment breaks. Recommendations have been proposed regarding management of esophageal cancer in the context of COVID-19, but none specifically address the issue of RT interruptions.Patients with other race and ethnicity and/or female sex were more likely to experience RT interruptions and prolonged RT duration. Race and ethnicity were not independently associated with inferior outcomes in the multivariable models, although US population–based studies have observed a higher rate of mortality in Black than in White patients with esophageal cancer, which may be explained in part by higher T category at diagnosis and decreased use of surgery.