Pre-Operative Chemoradiotherapy With or Without Induction Chemotherapy for Operable Locally-Advanced Esophageal Cancer

Abstract

was defined as chemotherapy and radiation starting within 14 days of each other, followed by chemotherapy, followed by definitive surgery four to six months later. Minimum follow up was 6 months, in order to account for immortal time bias. Multivariable logistic regression was performed to assess whether upfront chemotherapy followed by chemoradiation versus upfront chemoradiation followed by chemotherapy was significantly associated with pCR, defined as ypT0N0. Overall survival (OS) was analyzed via Kaplan-Meier method with the log-rank test. Multivariable Cox regression analysis was used to assess the impact of covariates on OS. Results: There were 9,393 TNT cases identified. Of these, 1522(16.2%) received C-CRT and 7871(83.8%) received CRT-C. The pCR was 12.2% in both groups. On multivariable logistic regression analyses, there was no difference in pCR based on the timing of the radiation (OR 0.987, 95% CI 0.824-1.183, P = .89). Kaplan-Meier analysis revealed that the 5-year OS rates for TNT was superior for C-CRT over CRT-C, with 5-year OS of 66.5% vs. 65.9% (P = 0020). However, on multivariable Cox regression, there was no significant difference in OS between C-CRT and CRT-C (HR = 0.981, 95% CI 0.864-1.115, P = 0772). Conclusion: In this large hospital-based study, most patients receiving TNT received chemoradiation upfront. There were no differences in pCR or overall survival based on the timing of the radiation treatments.