487 MINIMALLY INVASIVE ESOPHAGECTOMY AFTER A NEOADJUVANT PROTOCOL WITH INDUCTION CHEMOTHERAPY AND CHEMORADIATION

Abstract

Abstract Neoadjuvant chemoradiation (CR) became the standard of care for the treatment of resectable esophageal cancer, but the survival rates are still worse than the observed in other gastrointestinal malignancies. The optimal neoadjuvant approach is still matter of debate. Based on these considerations, we started a phase II trial (QUIMERA) to investigate the safety and efficacy of preoperative induction chemotherapy followed by CR and minimally invasive surgery for esophageal cancer. We report the initial results. Methods Patients with confirmed squamous cell or adenocarcinoma of the thoracic esophagus or GEJ (Siewert type I or II), aged 18–75 years, with a PS 0–2, clinical stage cT1b-3 cN0–2 were eligible. After staging, patients received two cycles of IC with carboplatin (175 mg/m2) and paclitaxel (AUC = 5) on days 1 and 22, followed by radiotherapy (45 Gy (25 x 1.8 Gy)) and chemotherapy (carboplatin (AUC = 2) and paclitaxel (50 mg/m2) weekly for five weeks. After re-staging, patients with no stage M1 disease and/or inoperable T4 disease proceeded to surgery, minimally invasive esophagectomy in prone position, 8–12 weeks after the completion of chemoradiation. Results From March 2017 to December 2019, 86 were registered in the clinical trial. Forty-eight were excluded due to T4 or M1 disease, 26 patients finished the IC + chemoradiation protocol. Sixteen minimally invasive esophagectomy were performed. There were no conversions to open surgery. The surgical outcomes are presented in Table 1. The mean node count in the surgical specimen was 27 (13-49). A complete pathological response was observed in 6 (37,5%) cases (4 SCC; 2 Adenocarcinoma). Conclusion Our initial results are encouraging and suggests that IC followed by chemoradiation is a safe, feasible, active and well-tolerated regimen and that it may increase the PCR, especially for squamous cell carcinoma. The minimally invasive esophagectomy following the IC + CR was feasible, safe and had an adequate oncologic result. After the protocol completion there will be data available for a definitive evaluation of the procedure.