Outcomes of patients with esophageal and gastric cancer in Sri Lanka: A retrospective survival analysis

Introduction

Esophageal carcinoma is the fourth most common cancer among males and sixth most common cancer among females in Sri Lanka. Gastric cancer is less common, but its incidence is gradually rising. We conducted a retrospective analysis of survival of esophageal and gastric cancer patients treated at National Cancer Institute, Maharagama, Sri Lanka.

Methodology

Patients with esophageal and gastric cancer treated in three selected oncology units of the National Cancer Institute, Maharagama during 2015 and 2016 were included in the study. Data on clinical and pathological factors were extracted from clinical records. Overall survival (OS), defined as time to death or loss to follow-up, was the primary endpoint. Univariate and multivariate analyses of survival were performed using the log-rank test and Cox proportional-hazard model, respectively.

Results

The study population comprised 374 patients with a median age of 62 years (interquartile range 55-70). Majority (64%) were male and had squamous cell carcinoma (58%). In the sample, 20% were gastric cancers, while 71% were esophageal cancers, and 9% had gastro-esophageal junction tumors. The 2-year OS was 19% in patients treated with curative intent (95% confidence interval [CI] 14-26 months) with those receiving neoadjuvant chemotherapy, followed by radical surgery having the highest survival (P < 0.001, hazard ratio 0.25 [95% CI 0.11-0.56]). Median OS was 2 months (95% CI 1-2 months) in patients treated with palliative intent.

Conclusion

Our results suggest that the outcome of patients with esophageal and gastric cancer is poor in Sri Lanka. Early detection and greater utilization of multimodality treatment could improve outcomes of these patients.

Lung Cancer Survival in Sri Lanka

Nuradh JosephIntroduction  Lung cancer is the second commonest cancer among males in Sri Lanka. Real-world survival data are scarce, and we conducted a retrospective survival analysis among patients treated for lung cancer. Methods  All patients with primary lung cancer treated at three selected units during 2015-2016 were included in the study. Data on clinicopathological and treatment delivered were extracted from clinic records. Overall survival was considered the primary end-point. Results  The study population comprised 349 patients. The median age was 61 years and majority of patients (74%) were males. Adenocarcinoma (56%) was the commonest histological subtype, followed by squamous cell carcinoma (26%), whereas 6% of patients had small cell lung cancer. Only 10% of patients with non-small cell lung cancer were treated with curative intent, whereas 67% presented with systemic metastases. The median overall survival was 12 months in patients treated with curative intent and there was no significant difference between radical surgery and radiotherapy. The median overall survival was 3 months in those treated palliatively. On multivariate analysis, female gender and first-line treatment with tyrosine kinase inhibitors was associated with superior survival. Conclusion  More than 90% of lung cancer patients in Sri Lanka are treated with palliative intent. Further work is needed to identify patient and care pathway barriers to ensure diagnosis at an earlier stage.

Curative-Intent Radiotherapy for Squamous Cell Carcinoma of the Head and Neck in Sri Lanka: The Impact of Radiotherapy Technique on Survival

AIMS

We conducted a retrospective analysis of patients with squamous cell carcinoma of the head and neck (SCCHN) treated with curative-intent radiotherapy at the National Cancer Institute of Sri Lanka to determine the impact of the treatment technique on disease-free survival (DFS).

MATERIALS AND METHODS

SCCHN patients treated with radical radiotherapy or adjuvant postoperative radiotherapy from 2016 to 2017 were included in the study. Data on the following variables were collected by reviewing clinical and radiotherapy treatment records: age, gender, tumour site, stage, time to delivery of radiotherapy, use of neoadjuvant chemotherapy, use of concurrent radiosensitising chemotherapy and treatment technique. DFS, defined as the time to death, tumour recurrence or loss to follow-up, was the primary end point and outcomes were compared between patients treated with intensity-modulated radiotherapy (IMRT) in linear accelerators and those treated with conventional radiotherapy in cobalt teletherapy units. Univariate and multivariate analyses were carried out on known prognostic variables.

RESULTS

In total, 408 patients were included in the study, with 138 (34%) being treated with IMRT in the linear accelerator. More than 75% of patients were of stage III or IV at diagnosis. The 2-year DFS of the whole cohort was 25% (95% confidence interval 21-30%). Patients treated with IMRT in the linear accelerator had a superior DFS in comparison with those treated with conventional radiotherapy in the cobalt teletherapy units (P < 0.001, hazard ratio 0.64, 95% confidence interval 0.5-0.82). Higher stage, cobalt treatment and use of neoadjuvant chemotherapy were adversely associated with DFS on multivariate analysis.

CONCLUSION

A large proportion of patients with SCCHN treated with curative-intent radiotherapy in Sri Lanka had locally advanced disease and DFS was superior in patients treated with IMRT in the linear accelerator.