2291 - Real-World Survival Outcomes across Radiotherapy-Based Care Pathways for Esophageal Cancer: A Population-Based Study from Hong Kong CADRS

Purpose/Objective(s):

Radiotherapy is delivered in diverse clinical contexts for esophageal cancer, including definitive, perioperative, and salvage settings. These treatment pathways represent heterogeneous clinical populations with different disease trajectories and management intents. However, population-level survival patterns across radiotherapy-based care pathways remain insufficiently described in real-world practice. Using territory-wide data from the Hong Kong Clinical Data Analysis and Reporting System (CADRS), we aimed to describe overall survival patterns and associated prognostic factors among patients with esophageal cancer treated with radiotherapy between 2007 and 2022.

Materials/Methods:

This retrospective population-based cohort study used data from the Hong Kong Clinical Data Analysis and Reporting System (CADRS) to identify patients with esophageal cancer who received radiotherapy between 2007 and 2022. Patients were categorized according to radiotherapy-based care pathways: definitive radiotherapy with or without chemotherapy, perioperative radiotherapy with or without chemotherapy combined with surgery, and salvage radiotherapy with or without additional treatment. Overall survival (OS) was estimated using the Kaplan–Meier method. Cox proportional hazards models were used to explore factors associated with OS.

Results:

A total of 1,926 patients were included, including 1,028 (53.4%) treated with definitive radiotherapy, 446 (23.1%) with perioperative radiotherapy, and 452 (23.5%) with salvage radiotherapy. Median OS differed across care pathways (P < 0.001). The median OS was 20.0 months (95% CI 16.3–24.1) in the perioperative group, 7.1 months (95% CI 6.4–7.8) in the definitive group, and 3.0 months (95% CI 2.5–3.6) in the salvage group. In multivariate analysis, care pathway classification and concurrent chemotherapy were independently associated with OS.

Conclusion:

In this large population-based real-world cohort, substantial variation in survival was observed across radiotherapy-based care pathways for esophageal cancer. These findings provide a descriptive overview of survival patterns in routine clinical practice and may inform future studies evaluating treatment sequencing and optimization strategies.