Definitive Concurrent Chemoradiotherapy with Paclitaxel plus Carboplatin in Squamous Cell Carcinoma of Esophagus Deemed Unsuitable for Surgery: Retrospective Audit from a Tertiary Cancer Center

Abstract

<h3>Purpose/Objective(s)</h3> Although neoadjuvant chemoradiotherapy (CTRT) followed by surgery is preferred, definitive CTRT is also one of the recommended management strategies for squamous cell carcinoma of esophagus (ESCC). Definitive CTRT protocols are evolving and data on the use of paclitaxel plus carboplatin (PC) is limited. The tolerance of induction chemotherapy may also be better than adjuvant chemotherapy in the definitive setting. We intend to analyze the demographics and clinical outcome of ESCC treated at our institute. <h3>Materials/Methods</h3> Data of 74 patients of ESCC treated with definitive RT with concurrent PC with or without induction chemotherapy were retrieved from departmental archives from Jan 2016 to Aug 2021. Induction chemotherapy was with weekly PC (Pac 80 mg/m²+ carboplatin AUC 2 intravenous Day 1) followed by definitive RT alone or CTRT (same as induction regimen except Pac 50mg/m²). Disease free survival (DFS) and overall survival (OS) were estimated from the date of registration using Kaplan Meier method. <h3>Results</h3> Patient characteristics are summarized in table 1. Median RT dose for RT alone group and CTRT group was 60 and 50 Gray respectively (3-dimensional conformal plans). Median number of induction and CCRT cycles was 4 (2-6) and 4 (3-6) respectively. Grade 3 leucopenia, dysphagia and pneumonitis was noted in 5.4%, 16% and 6.75% patients respectively. At a median follow up of 16 months, local progression was seen in 33% and distant failure in 19% of patients. 1-year and 2-year OS was 62% and 32% and DFS was 43.9% and 25% respectively. The median OS and DFS in the CCRT group were better than RT alone group (15.93 <i>vs</i>. 8.95 months, <i>p</i> = 0.004 & 11.34 vs. 4.85 months, <i>p</i> = 0.003 respectively). Median OS and DFS in patients who achieved complete response after RT had better outcome than those who did not achieve complete response (29.83 vs. 11.18 months, <i>p</i> = < 0.001 & 22.75 vs. 4.95 months, <i>p</i> = < 0.001 respectively). <h3>Conclusion</h3> ESCC treated with CCRT using weekly PC have decent survival outcome and significantly better than with RT alone. Complete response after RT predicts a better DFS and OS in this cohort of patients.