A Retrospective Study on Treatment Outcomes of Locally Advanced Esophageal Squamous Cell Carcinoma After Radical Treatment at Kenyatta National Hospital

Abstract

Oesophageal cancer is linked to poor prognosis, especially in Kenya where there is a high mortality and the most common histology being squamous cell carcinoma which is related to poor treatment outcomes. Objective The objective of this study was to assess the treatment outcomes of locally advanced oesophageal squamous cell carcinoma patients after radical treatment at KNH CTC between 2018 and 2019. Methods This study utilized a retrospective cohort study design through consecutive sampling of patient files for patients diagnosed and treated radically for oesophageal squamous cell carcinoma within the KNH CTC. Data was recorded in data abstraction forms and later entered into EpiData software for data collection. Data was analysed using R software version 4.1.2. Continuous data was analysed using means and standard deviations. Categorical data was summarised using frequencies and proportions. Kaplan-Meier analysis was used to determine survival of patients for the 3-year period. Results: The mean age of the participants was 57.3 years with a standard deviation of 12.5 years. The majority, 59.7% (n = 80) of the patients were males. Of the 134 patients, 38.8% (n = 52) were in clinical stage III followed by 36.8% (n = 36.6%) in clinical stage IVA. Stage IVA had the highest proportion of mortality at 96.7%. There was a slight difference in proportion between the patients who died in stages II and III. The rest were in clinical stage II. 45.9% (n = 61) had cancer in the mid thoracic region of the oesophagus followed by 37.6% (n = 50) in the lower thoracic region. Seventeen (12.8%) patients had cancers in the upper oesophagus and the rest in the cervical region. The most administered treatment was neoadjuvant chemoradiotherapy without surgery at 47.8% (n = 64) followed by definitive chemoradiotherapy at 26.1% (n = 35). Neoadjuvant chemoradiotherapy with surgery had the highest survival probability. Overall survival at 1, 2 and 3 years was 42.1, 14.9 and 5% respectively. Conclusion: More than 50% of the patients had cancer stages III and IVA. Mortality was high among the advanced stages of cancer. Oesophageal cancers that occurred in the middle oesophagus region made up the largest single proportion and had heighted mortality compared to other sites. Neoadjuvant chemoradiotherapy plus surgery had the highest survival probability at one and two years compared to the other treatments. Survival of the patients with locally advanced oesophageal cancer was low compared to most studies in the literature.