Short-term Outcomes in Patients with Carcinoma of the Esophagus and Gastroesophageal Junction Receiving Neoadjuvant Chemotherapy or Chemoradiation before Surgery. A Prospective Study.

Syed Nusrath,Krishnam Raju,Sudha Murthy,Ayyagari Santa,Satish Pawar,Subramanyeshwar Rao Thammineedi,Krishna Mohan Mallavarapu,Senthil J Rajappa,K V Vijaya Narsimha Raju,Sujit Chyau Patnaik

doi:10.5041/rmmj.10339

Abstract

BackgroundNeoadjuvant chemotherapy (NACT) and neoadjuvant chemoradiotherapy (NACRT) have been demonstrated to improve survival compared to surgery alone in esophageal carcinoma, but the evidence is scarce on which of these therapies is more beneficial, particularly with regard to resectability rates, postoperative morbidity and mortality, and histological responses.ObjectiveThis study compares the resectability, pathological response rates, and short-term surgical outcomes in patients with carcinoma of the esophagus or gastroesophageal junction receiving NACT or NACRT prior to surgery.MethodsPatients with resectable carcinoma of the esophagus or gastroesophageal junction adenocarcinoma, squamous cell carcinoma, and adenosquamous histologies were enrolled in this well-matched prospective non-randomized study. Thirty-five patients were given NACT, and 35 NACRT. In the NACT group, 25 patients received three cycles of three-weekly carboplatin and paclitaxel, and 10 received three cycles of cisplatin/5-fluorouracil, while all the patients in the NACRT group received 41.4 Gy of radiotherapy concomitant with five cycles of weekly paclitaxel and carboplatin-based chemotherapy.ResultsTwenty-two patients in the NACT group and 33 patients in NACRT group had resection (P value = 0.0027). The percentage of microscopically margin-negative resection (R0 resection) was similar in both the groups (86% versus 88%). The incidences of surgical and non-surgical complications were similar in both the groups (P=0.34). There was no 30-day mortality. There was a trend toward more pathological complete regression in the NACRT group (P=0.067). The percentage of patients achieving complete tumor regression at the primary site (pT0) was significantly higher in the NACRT group. The down-staging effect on nodal status was similar in both the groups (P=0.55). There was a statistically significant reduction in tumor size in the NACRT group. The median numbers of nodes harvested and positive nodes were similar in both the groups.ConclusionPatients receiving NACRT had better resectability rates and pathological response rates, but similar postoperative morbidity compared to the NACT group.

Highlights

Esophageal and gastroesophageal junctional cancers are aggressive tumors
There was a trend toward more pathological complete regression in the neoadjuvant chemoradiotherapy (NACRT) group (P=0.067)
The rationale for neoadjuvant chemotherapy (NACT) and neoadjuvant chemoradiotherapy (NACRT) in locally advanced esophageal cancer patients is due to the poor survival rate with surgery alone and the early local and systemic relapses

Summary

Introduction

Esophageal and gastroesophageal junctional cancers are aggressive tumors. surgery is the prime modality of treatment, cancer recurs in most patients within 2 years after resection, and the patients have a poor median overall survival of 15–18 months.[1]. Neoadjuvant therapy is an attractive option in esophageal cancer where the adjuvant treatment can be completed prior to surgery. The rationale for neoadjuvant chemotherapy (NACT) and neoadjuvant chemoradiotherapy (NACRT) in locally advanced esophageal cancer patients is due to the poor survival rate with surgery alone and the early local and systemic relapses. Neoadjuvant chemotherapy (NACT) and neoadjuvant chemoradiotherapy (NACRT) have been demonstrated to improve survival compared to surgery alone in esophageal carcinoma, but the evidence is scarce on which of these therapies is more beneficial, with regard to resectability rates, postoperative morbidity and mortality, and histological responses

Methods

Results

Discussion

Conclusion