Nuclear Medicine & Radiation Therapy

Chemoradiotherapy Using Volumetric Modulated Arc Therapy for Locally Advanced Esophageal Cancer: A Single Institute Experience

Abstract

Adeel Riaz, Syed Mohsin Raza, Ayesha Afzal, Mariam Arif, Abu Hurairah, Varisha A. Hussain, Daniyal Ahmed Sami and Muhammad Mohsin Fareed

Objective: Locoregional failure after trimodailty treatment is a crucial problem for locally advanced esophageal carcinomas. The goal of this study is to assess outcomes of preoperative chemoradiation followed by esophagectomy in locally advanced esophageal carcinomas. Material and Methods: Patients with cT3-T4 or node+ esophageal carcinomas receiving trimodality treatment (2017-2020) were analyzed retrospectively. Demographics, histology, grade, stage, dose, fractionation, chemotherapy, surgery and resection margins were analyzed. Primary end points were Disease Free Survival (DFS) and Overall Survival (OS). Results: 122 patients were included, mean follow-up of 13.4 months. 99 (82%) patients had cT3 and 58(47.5%) had cN1 disease. Most common histology was Squamous Cell 102 (83.6%), grade was moderate 92 (75.4%) and most patients received chemotherapy, induction (n=99, 81%) vs. concurrent (n=116, 95%). Chemoradiation 50 Gy in 25 fractions with platinum-based chemotherapy was the most common regimen. 65 patients were treated with definitive intent; and 57 patients with pre-operative intent, of whom 56 (98%) underwent surgery. Most common surgery was 3-stage esophagectomy. In the pre-operative group, R0 resection was achieved in 38 patients (66.7%). 2-year OS was better in pre-operative group compared to definitive group (72% vs. 32%, p=0.001). Similarly, 2-year DFS was better in pre-operative group compared to definitive group (78% vs. 52%, p=0.03). R0 resection and radiation dose of 50Gy were associated with better overall survival on MVA. Disease recurrence was seen in 34 (27.9%) with local recurrence in 10 (8.2%), distant metastasis in 20 (16.4%) and both in 4 (3.3%) patients. Conclusion: Trimodality treatment with standard preoperative radiation dose and chemotherapy yielded a high pathologic complete response rate and better 2-year DFS and OS. R0 resection and 50 Gy radiation dose were associated with better OS.