Survival Between Neoadjuvant and Definitive Chemoradiotherapy In Locally Advanced Esophageal Cancer

Abstract

Background: Most patients with esophageal cancer presented in loco-regional stage and standard treatment involve neoadjuvant chemoradiotherapy (nCRT) followed by surgery. However, when patients have severe medical problems or refuse surgery they will receive definitive chemoradiation (dCRT). Therefore, studies evaluating the necessity of surgery remain of interest.

Methods: Data were retrospectively collected from locally advanced esophageal squamous cell carcinoma (ESCC) patients at Songklanagarind Hospital from January 2012 to December 2019. All patients received concurrent chemoradiation with platinum and 5-fluorouracil (5FU) based chemotherapy regimens. Then they would be divided into 2 groups (nCRT and dCRT groups). Survival rates in both groups were demonstrated using Kaplan-Meier curve and factors affecting the log-rank test were compared.

Results: We included 110 patients treated between 2012 and 2019: 22 (20%) with nCRT and 88 (80%) with dCRT. Median OS and DFS were 12 and 7.59 months for nCRT vs. 19.7 and 8.57 months for dCRT (HR 0.7 in OS, 95%CI=0.41-1.22, p = 0.204). The prognostic factors included sex, former alcohol consumption and option treatment that were independently associated with OS.

Conclusion: In ESCC patients treated with either nCRT or dCRT showed the similar median OS and DFS in both groups that might cause from more postoperative morbidity or mortality in nCRT patient group. Sex, former alcohol consumption and option treatment were the prognostic factors to the OS in locally advanced ESCC. It responded very well to dCRT which might affect to survival.