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Assessment of a collaborative treatment model for trimodal management of esophageal cancer.
Udelsman, Brooks V; Ermer, Theresa; Ely, Sora; Canavan, Maureen E; Zhan, Peter; Boffa, Daniel J; Blasberg, Justin D.
Afiliación
  • Udelsman BV; Division of Thoracic Surgery, Department of Surgery University of Southern California, Los Angeles, CA, USA.
  • Ermer T; Division of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
  • Ely S; London School of Hygiene and Tropical Medicine, University of London, London, UK.
  • Canavan ME; Division of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
  • Zhan P; Cancer Outcomes Public Policy and Effectiveness Research Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
  • Boffa DJ; Division of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
  • Blasberg JD; Division of Thoracic Surgery, Yale School of Medicine, New Haven, CT, USA.
J Thorac Dis ; 15(9): 4668-4680, 2023 Sep 28.
Article en En | MEDLINE | ID: mdl-37868899
Background: Patients with esophageal cancer often receive care in a collaborative (multi-institutional) treatment model as opposed to a single institutional model. The effect of a collaborative model on the quality of trimodality therapy and survival is unknown. Methods: The National Cancer Database (NCDB) was used to identify patients receiving neoadjuvant chemoradiotherapy (CRT) followed by esophagectomy for esophageal cancer between 2012-2017. Patients who received neoadjuvant therapy and surgery at a single institution were compared to those that received collaborative treatment across multiple institutions. Outcomes included adherence to guideline recommended multiagent chemotherapy, receipt of 41.4-50.4 Gy of radiation, R0 resection, pathologic complete response (pCR), and 5-year survival. Sociodemographics, comorbidities, and tumor characteristics were assessed in bivariate and multivariable analysis. Results: Among 8,396 patients identified, 39% received treatment at a single institution, while 61% received collaborative treatment. Median travel distance to the site of esophagectomy was two times greater for patients receiving collaborative treatment (30 vs. 15 miles; P<0.001). Patients in the collaborative cohort were less likely to receive guideline-recommended multiagent chemotherapy (85% vs. 96%; P<0.001) and 41.4-50.4 Gy of radiation (89% vs. 91%; P=0.01). R0 resection rates were similar (94.4% vs. 93.7%; P=0.17). Patients who received collaborative treatment had an increased rate of pCR (24% vs. 22%; P=0.02). Overall, 90-day and 5-year survival were 92.9% and 42.6% respectively and did not differ significantly between the two groups. Conclusions: Collaborative trimodality treatment of esophageal cancer is a common and reasonable practice model, which may alleviate patient travel burden with only a modest impact on the quality of CRT, pCR, 90-day survival, and 5-year survival.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Thorac Dis Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: China

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Thorac Dis Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: China