PS02.127: PREOPERATIVE CHEMORADIATION IN CARCINOMA OF ESOPHAGUS: A RETROSPECTIVE CLINICAL AUDIT IN A SINGLE RURAL CANCER CENTRE IN INDIA

Abstract

Abstract Background The current standard of care for the treatment of surgically resectable carcinoma of esophagus is preoperative chemoradiation followed by surgery. There is strong evidence that this trimodality approach improves survival as compared to surgery alone. We intended to study the feasibility of this approach in a single rural cancer centre in Western India. Methods We did the retrospective analysis of consecutively treated patients of resectable carcinoma of esophagus from March 2013 till March 2017. All patients underwent endoscopic evaluation of upper gastro-intestinal tract, biopsy, CT scan of thorax with abdomen and hematological counts for determining fitness for chemotherapy. All biopsy proven, treatment naïve, non metastatic cases of carcinoma of thoracic esophagus and gastro-esophageal region were included in the analysis. All patients underwent neoadjuvant radiochemotherapy. Radiotherapy was given with conformal technique with concomitant chemotherapy either oral capecitabine or injectable paclitaxel and carboplatin or 5FU with cisplatin. Response was evaluated after 4–6 weeks of neoadjuvant therapy with CT scan and patient were subjected for esophagectomy. Results One hundred and fifty eight patients were treated with neoadjuvant radiotherapy and concomitant chemotherapy. Response to this therapy was assessed by CT scan in 119 patients out of which 70% showed partial response. Esophagectomy was done in seventy patients. Histopathology report revealed complete pathological response [pCR] in 29%. At the median follow up of 36 months, the median survival of the patients who underwent surgery is 15 months as against 7 months for those who did not undergo surgery. Patients with pCR had median survival of 19 months. Conclusion The trimodality approach is feasible in rural set up with comparable survival outcomes with literature. The patients who underwent complete pathological response did better than those with partial pathological response. There is concern about drop-out rates after neoadjuvant radiochemotherapy due to various reasons; prime being the socio-economic constraints. This audit gave us insight into the strategic selection of the patients for the trimodality approach as well as continuous socioeconomic support throughout the treatment course. Disclosure All authors have declared no conflicts of interest.