Neoadjuvant and Definitive Radiochemotherapeutic Approaches in Esophageal Cancer: A Retrospective Evaluation of 122 Cases in Daily Clinical Routine

Abstract

Introduction: Esophageal cancer (EC) is a common malignant tumor entity with increasing occurrence. The incidence of esophageal adenocarcinoma (AC), particularly, is constantly rising in the Western world. The mainstays of therapy with curative intent for EC in advanced stages are neoadjuvant radiochemotherapy (neoRCT) with surgery and definitive radiochemotherapy (defRCT). Methods: We examined our internal files to identify patients suffering from EC. Palliative cases were excluded. Statistical testing was performed by χ 2 test, Student's t test, Kaplan-Meier analyses, and the Mann-Whitney U test. Results: One hundred and twentytwo cases were included. Histology revealed squamous cell carcinoma in 92 cases and AC in 23 cases. Ninety-five patients underwent defRCT, 27 underwent neoRCT, and 114 (in both therapy regimes) received simultaneous chemotherapy. There was no difference in the overall survival (OS) (p = 0.654; HR 1.145; 95% CI 0.629-2.086) or and progression-free survival (PFS) (p = 0.912) of patients who underwent neoRCT or defRCT. Median OS was 13.5 (2-197) months for defRCT patients and 19.5 (2-134) months for neoRCT patients (p = 0.751). Karnofsky index (KI) with a cutoff of 70% was strongest, but not a significant parameter for OS (p = 0.608) or PFS (p = 0.137). Conclusion: defRCT is a valid and an equal alternative to neoRCT for patients suffering from EC. Selection of patients for therapy is of crucial relevance. Further studies and improvements in follow-up are needed when neoRCT has been completed before surgery, in order to spare the patient undergoing operative treatment if there is complete remission. The identification of valid markers urgently needed to limit treatment side effects.

Neoadjuvant versus definitive radiochemotherapy of locoregionally advanced oesophageal cancer—who benefits?

“…To show the whole patient population treated with curative intent, we did not set inclusion criteria such as performance status limits or freedom of any metastasis (as we included curatively treated oligometastases), as other retrospective analyses did [ 12 ]. This might have led to lower survival rates for dRCT in our study compared to other data, while our nRCT‑S rates are similar or even higher [ 10 – 13 ]. However, survival rates range widely in the literature, probably depending on the study design.…”

“…In terms of CTx, the dRCT group included patients not receiving any CTx because of high-grade comorbidities, underscoring the differences in general health constitution between the treatment groups. Similarly, compliance with full-dose CTx was lower in our study than in other studies [ 10 , 12 , 13 ] due to the high incidence of comorbidities.…”

“…The contribution of our study to the discussion regarding the optimal treatment for locoregionally advanced OC emphasizes that patients with none or few comorbidities seem to profit from nRCT‑S. However, the trend in recent literature has been towards equal effectiveness of dRCT [ 10 – 13 ].…”

“…However, the superiority of such a trimodal approach over definitive radiochemotherapy without surgery (dRCT) has been controversial for many years, including in randomized controlled trials [ 6 – 11 ]. Recently, two retrospective studies found no significant difference in overall survival [ 12 , 13 ].…”

Comparison of outcomes between neoadjuvant treatment followed by surgery and surgical treatment alone in patients with locally advanced esophageal cancer: Our single-center experience

“…In the literature, there are also publications reporting that patients receiving only CRT in squamous cell esophageal cancers had similar overall survival rates compared to those who underwent surgery after NCRT. [ 9 , 10 ] These studies have shown that there is no need for surgery, particularly in patients with complete response after CRT. One of the important problems is to detect the complete pathological response.…”