363. THE MODALITY OF NEOADJUVANT VERSUS ADJUVANT CHEMORADIOTHERAPY FOR LOCALLY ADVANCED ESOPHAGEAL. CARCINOMA: A SINGLE CENTER, RANDOMIZED, CLINICAL TRIAL

Abstract

Abstract Neoadjuvant chemoradiotherapy (nCRT) plus surgery is recommended as standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC). However, studies have shown that surgery combined with adjuvant chemoradiotherapy (aCRT) can also provide survival benefits. The optimal modality of surgery combined chemoradiotherapy for esophageal cancer have not been determined yet. From March 2018 to January 2021, 203 patients with resectable middle and lower thoracic ESCC, were enrolled in this prospective study. Patients were randomized into two groups: nCRT plus minimally invasive esophagectomy (MIE), MIE plus aCRT. In nCRT group, the patients were treated with paclitaxel plus carboplatin for two cycles, with a total concurrent radiation dose of 40.0Gy. In aCRT group, the patients with pN (+) were treated with paclitaxel plus carboplatin for four cycles, with a total sequential radiation dose of 54.0Gy, The primary end points were 3-year OS and DFS on the analysis of an intention-to-treat basis. 74 patients received surgery in the nCRT group，99 patients received surgery in aCRT group. Among 74 patients in nCRT group, 62 patients (83.8%) underwent MIE, compared with 88 of 99 (88.9%) in aCRT group (P = 0.65). With median follow-up of 28.4 months for all the enrolled patients, no significant differences were found in the 3-year OS (77.2% vs 75.8% P = 0.82) and DFS (60.9% vs 60.6% P = 0.86) among nCRT and aCRT groups. Postoperative complications did not differ significantly between groups, except for arrhythmia, which occurred more frequently in nCRT group (31.1%) than in aCRT group (14.1%) (P = 0.07). Initial results of the trial showed that the treatment modality of nCRT followed by MIE has similar safety and survival benefit to that of MIE combined aCRT for locally advanced ESCC.