Short-term Outcomes in Patients with Carcinoma of the Esophagus and Gastroesophageal Junction Receiving Neoadjuvant Chemotherapy or Chemoradiation before Surgery. A Prospective Study

Abstract

Background Neoadjuvant chemotherapy (NACT) and neoadjuvant chemoradiotherapy (NACRT) have been demonstrated to improve survival compared to surgery alone in esophageal carcinoma, but the evidence is scarce on which of these therapies is more beneficial, particularly with regard to resectability rates, postoperative morbidity and mortality, and histological responses. Objective This study compares the resectability, pathological response rates, and short-term surgical outcomes in patients with carcinoma of the esophagus or gastroesophageal junction receiving NACT or NACRT prior to surgery. Methods Patients with resectable carcinoma of the esophagus or gastroesophageal junction adenocarcinoma, squamous cell carcinoma, and adenosquamous histologies were enrolled in this well-matched prospective non-randomized study. Thirty-five patients were given NACT, and 35 NACRT. In the NACT group, 25 patients received three cycles of three-weekly carboplatin and paclitaxel, and 10 received three cycles of cisplatin/5-fluorouracil, while all the patients in the NACRT group received 41.4 Gy of radiotherapy concomitant with five cycles of weekly paclitaxel and carboplatin-based chemotherapy. Results Twenty-two patients in the NACT group and 33 patients in NACRT group had resection ( P value = 0.0027). The percentage of microscopically margin-negative resection (R0 resection) was similar in both the groups (86% versus 88%). The incidences of surgical and non-surgical complications were similar in both the groups ( P= 0.34). There was no 30-day mortality. There was a trend toward more pathological complete regression in the NACRT group ( P= 0.067). The percentage of patients achieving complete tumor regression at the primary site (pT0) was significantly higher in the NACRT group. The down-staging effect on nodal status was similar in both the groups ( P= 0.55). There was a statistically significant reduction in tumor size in the NACRT group. The median numbers of nodes harvested and positive nodes were similar in both the groups. Conclusion Patients receiving NACRT had better resectability rates and pathological response rates, but similar postoperative morbidity compared to the NACT group.

Short-term outcome of Ivor Lewis esophagectomy following neoadjuvant chemoradiation versus perioperative chemotherapy in patients with locally advanced adenocarcinoma of the esophagus and gastroesophageal junction: a propensity score-matched analysis

“…In the recent past, several analyses were published covering this topic. These studies did not compare FLOT versus CROSS, but different regimens of pCT versus nCRT (Stahl et al 2009 ; Swisher et al 2010 ; Burmeister et al 2011 ; Klevebro et al 2016 ) in cohorts that were either exclusively patients with esophageal/gastroesophageal adenocarcinoma (Stahl et al 2009 ; Burmeister et al 2011 ) or where the majority of patients showed this histological subtype (Swisher et al 2010 ; Klevebro et al 2016 ; Nusrath et al 2019 ). The results are still heterogeneous.…”

Neoadjuvant immunotherapy improves outcomes for resectable gastroesophageal junction cancer: A systematic review and meta‐analysis

“… 51 On the contrary, by combining radiotherapy with immunotherapy, radiation oncologists may take into account the viability of reducing radiation dose, restricting the target area, and including field exposures to lower the risk of fatality. Also, the average surgical resection rate was 90%, indicating that NAIT use did not lower patients' surgical resection rates relative to the 85%–95% 52 , 53 surgical resection rate revealed by nCT. According to the subgroup analysis of NAIT combined with nCT or nCRT, we believe NAIT in conjunction with CRT was more effective in MPR and PCR and had a greater safety compared with NAIT combined with nCT.…”

Pathologic complete response in patients with esophageal cancer receiving neoadjuvant chemotherapy or chemoradiation: A systematic review and meta‐analysis

“…The full‐text publications for the remaining 191 studies were reviewed. Of these, 84 studies 7,26–108 met the inclusion and exclusion criteria and were included in this systematic review and meta‐analysis, yielding a total of 6451 patients who received neoadjuvant therapy and had tumor response measured pathologically after surgery. Of the 84 included trials, 13 (15%) were published between 1992 and 2001, 31 (37%) between 2002 and 2011, and 41 (49%) between 2012 and 2022.…”