THE IMPACT OF LATE INITIATION OF TREATMENT ON ESOPHAGEAL CANCER PATIENTS UNDERGOING DEFINITIVE CHEMORADIOTHERAPY

Introduction: Managing esophageal cancer patients is still a major challenge. Delay in starting esophageal cancer treatment is an uncertain topic. In our study, we proposed an evaluation of the influence of delayed initiation of treatment in esophageal cancer patients undergoing definitive chemoradiotherapy. Methods: We conducted a retrospective study of esophageal cancer patients diagnosed between 2000 and 2016 and treated at the Hospital de Clínicas da UNICAMP and began treatment within 90 days of histological diagnosis. We analyzed only patients without metastasis in the diagnoses and who underwent definitive chemoradiotherapy. Patients were grouped at the beginning of treatment in less than 60 days and between 60 and 90 days (with delay). Both groups were compared with age, sex, body mass index, weight loss at diagnosis, histology, topography, ECOG scale, chemotherapy scheme, high-grade toxicity during treatment, presence of comorbidities (hypertension, dyslipidemia, diabetes, cirrhosis and COPD) and delay in starting treatment. The variables were initially compared in the chi-square and t-student tests. Overall survival (OS) and progression-free survival (PFS) were compared in a Cox multivariate proportional hazard proportional regression, with a previous selection of variables with a minimum significance of P <0.10 in a previous univariate analysis. Results: A total of 152 patients were analyzed, 71 (46.7%) without delay and 81 (53.3%) with delay. Only high-grade toxicity showed a significant difference in the groups, 50.7% in those without delay and 33.3% in the delay group (P = 0.03). Patients without delay had a median PFS of 9.2 months (95% confidence interval [CI]: 5.1 – 11.3) versus 5.1 months (95% CI: 3.9 – 6.5) in the group with delay (P = 0.024). The group with no delay had a OS of 13.6 months (95% CI: 10.5 – 21.7) versus 9.4 months (95% CI: 6.7 – 11.1) in the delay group (P = 0.013). In multivariate analysis, delayed initiation of treatment was associated with worse risk of progression (HR: 1.58 95% CI: 1.10 – 2.29, P = 0.015) and death (HR: 1.76 95% CI: 1.21 – 2.58, P <0.001). Conclusion: Delay in starting treatment was associated with a higher risk of progression and death. Strategies to reduce this delay represent great potential for health promotion.