ESTRO 2023

Session Item

Upper GI

Session Code: 6010

Session Type: Poster (Digital)

Track: Clinical

Neoadjuvant versus definitive chemoradiation for esophageal cancer: a retrospective analysis

reinhilde weytjens, Belgium

Presentation Number: PO-1383

Abstract

Abstract Title:

Neoadjuvant versus definitive chemoradiation for esophageal cancer: a retrospective analysis

Authors:

Ines Joye^1,2, Saartje Vermeulen³, Thomas Op de Beeck³, Nick Geudens³, Timon Vandamme⁴, Marc Simoens⁵, Thomas Botelberge⁶, Jody Valk⁷, Michiel de Maat⁸, Willem Lybaert⁹, Wim Demey¹⁰, Melanie Machiels¹¹, Daan Nevens¹, Charlotte Billiet¹, Paul Meijnders¹, Carole Mercier¹, Sabine Vanderkam¹, Reinhilde Weytjens¹, Steven Van Laere²

¹Iridium Netwerk, Department of Radiation Oncology, Wilrijk, Belgium; ²University of Antwerp, Integrated Personalised and Precision Oncology Network, Antwerpen, Belgium; ³University of Antwerp, Department of Medicine, Antwerpen, Belgium; ⁴University Hospitals Antwerp, Department of Oncology, Edegem, Belgium; ⁵Ziekenhuis Netwerk Antwerpen (ZNA), Department of Gastroenterology, Antwerpen, Belgium; ⁶GasthuisZusters Antwerpen (GZA), Department of Gastroenterology, Wilrijk, Belgium; ⁷Ziekenhuis Netwerk Antwerpen (ZNA), Department of Surgery, Antwerpen, Belgium; ⁸University Hospitals Antwerp, Department of Surgery, Edegem, Belgium; ⁹VITAZ , Department of Oncology, Sint-Niklaas, Belgium; ¹⁰KLINA, Department of Oncology, Brasschaat, Belgium; ¹¹Iridium Netwerk , Department of Radiation Oncology, Wilrijk, Belgium

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Purpose or Objective

Esophageal and gastroesophageal (GE) tumors have a poor prognosis with a 5-year relative survival of around 25%. Currently, limited data exists comparing definitive chemoradiotherapy (dCRT) with neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy. We analyzed outcomes of patients treated with dCRT and nCRT, focusing on overall survival (OS), local and distant recurrences as well as on acute and late toxicity.

Material and Methods

Patients with esophageal and GE tumors treated with dCRT or nCRT followed by surgery between January 2001 and December 2019 were retrospectively analyzed. Only patients treated with curative intent were included. OS, local recurrence (LR), distant metastasis free survival (DMFS) and early (<6 months) as well as late (>6 months) toxicity were determined. GLMs were used for categorical variables while Cox proportional hazard regression was performed for OS, LR and DMFS. Survival curves were analyzed using Kaplan-Meier analysis. Data analysis was performed in R and p-values below 5% were considered significant. The study was approved by the institutional ethical committee.

Results

A total of 300 patients were identified of which 160 underwent nCRT followed by surgery and 140 were treated with dCRT. Patient characteristics are depicted in Table 1. After a mean follow-up of 30.8 months, a tendency towards a better OS was observed in univariate analysis for patients treated with nCRT (HR 0.771; 95% CI 0.577-1.029; p-value 0.076) (Fig. 1). This tendency could not be confirmed in multivariate analysis. LR occurred in 40 patients (23 and 17 events for dCRT and nCRT resp.). No statistically significant difference in LR was observed between nCRT and dCRT (HR 0.608; 95% CI 0.325-1.138; p-value 0.120). Tumor location (mid vs. distal; HR 2.057), radiation dose (≥50 Gy vs. 50 Gy ; HR 2.097), treatment technique (VMAT vs. 3D-CRT; HR 0.366) and type of chemotherapy (Cis-5-FU vs. Carbo-Taxol; HR 2.703) appeared significant in univariate analysis, but not in multivariate analysis. Distant metastases occurred in 80 patients (30 and 50 events for dCRT and nCRT resp.). Analysis of DMFS demonstrated a tendency towards significance in univariate analysis in favor of dCRT (HR 1.511; 95% CI 0.961-2.377; p-value 0.072), which could not be confirmed after multivariate analysis. Age and histology appeared (borderline) significant in multivariate analysis in favor of female gender (HR 0.450; p-value 0.027) and squamous cell carcinoma (HR 0.627; p-value 0.074). There was a significantly higher prevalence of early respiratory toxicity in the nCRT subgroup (OR 1.849; 95% CI 1.005-3.401; p-value 0.048).

Table 1: Patient characteristics

Fig. 1: OS by treatment modality

Conclusion

Our analysis study was unable to demonstrate any statistically significant difference in OS in patients treated with dCRT or nCRT. Shared-decision making and tailoring treatment to the various patient- and treatment-related factors are crucial when defining the optimal treatment plan.