Session Item

The treatment of esophageal cancer (EC) and gastroesophageal junction carcinoma (GEJC) may vary significantly in daily clinical practice, as different pre- and peri-operative strategies are included in current international guidelines.

We conducted a pattern of care survey to assess the current management of patients with EC and GEJC in Italy (40 questions) among centers with experience in the field. Twenty-five questionnaires were analyzed.

Most of the respondents work in public and/or university hospitals/IRCCS (92%) in northern Italy (68%). About half (56%) of centers treat 10-20 patients/year (16% > 30 patients/year). Most centers manage patients in a multidisciplinary team (84%). Common examinations for baseline staging include EGDS (100%, usually with EUS), CT scan (100%), and 18FDG-PET/CT scan (92%). The need for jejunostomy/PEG is evaluated on a case-by-case basis in roughly half of cases (44%). For early-stage EC (cT2N0) neoadjuvant radio-chemotherapy (nRCT) is considered instead of upfront surgery in case of high-risk lesions (poorly differentiated, LVI, > 3 cm) by 64% of respondents. For locally advanced EC (cT2-4aN0/+), nRCT followed by surgery is adopted as standard approach in both esophageal squamous cell carcinoma (SCC) (96%) and adenocarcinoma (ADC) (92%). For locally advanced GEJC (cT2-4aN0/+), neoadjuvant radio-chemotherapy (nRCT) followed by surgery is considered standard of care in Siewert I-II lesions (88%), while perioperative chemotherapy represents the treatment of choice in Siewert III lesions (88%). Induction chemotherapy prior to nRCT is considered for extensive locally advanced disease (e.g., cT4b, suspicious extra-regional nodes) by 76% of respondents. The most frequently prescribed doses are 41.4 Gy/23 fractions (64%) and 50.4-56 Gy/25-28 fractions (40%) in neoadjuvant and definitive setting, respectively. Variability is present in CTV and PTV definition, prescription dose, and organ motion management (table 1). Most participants use VMAT (76%) and daily volumetric IGRT (80%). Regarding concurrent chemotherapy, carboplatin-paclitaxel represents the standard of care for ADC and SCC in 80% and 64% of centers, respectively. Response evaluation is performed within 8 weeks (100%) to the end of nRCT. In case of complete response to nRCT, a watch-and-wait approach with salvage surgery is considered in selected SCC patients in 44% of centers. In the adjuvant setting, patients underwent upfront surgery are considered for postoperative radiotherapy (PORT) in case of non-radical surgery (R1/2) (96%) and/or pN+ (72%); conversely, in patients undergoing perioperative chemotherapy and surgery, the addition of PORT is considered exclusively in case of R1/2 by 60% of respondents.

Differences were observed among centers in the management of EC and GEJC. The results of this survey provide baseline data for future research and to harmonize treatment recommendations for EC and GEJC patients in Italy.