Neoadjuvant Chemotherapy vs Chemoradiotherapy for Malignancy of Esophagus: A Prospective Comparative Study

Neoadjuvant chemoradiation (NACRT) followed by surgery has become the standard of care for esophageal squamous cell carcinoma (ESCC). This study compared the tolerability and oncological benefit of neoadjuvant chemotherapy (NACT) with those of NACRT for the treatment of ESCC.

A prospective quasi-experimental comparative study was conducted from July 2019 to August 2023 to assess the efficacy of the NACT regimen of two cycles of paclitaxel and carboplatin as an alternative to standard NACRT. Either NACT or NACRT was given to patients with resectable ESCC (clinical stage IB-IIIC), after which they underwent minimally invasive esophagectomy with two-field lymphadenectomy. Radiological and pathological responses to neoadjuvant therapy, perioperative morbidity, mortality, and recurrence-free and overall survival rates were compared.

Out of the 74 patients enrolled, 63 were included in the study after exclusion. Of these, 30 received NACT, and 33 received NACRT. The baseline demographics, tumor characteristics, incidence of neoadjuvant therapy-related adverse events, and perioperative morbidity were comparable between the two groups. The median number of lymph nodes retrieved (21 vs 19, p=0.19) and R0 resection rate (100% vs 94%) were similar. Although the pathological response was significantly better in the NACRT arm, at a median follow-up of 32.5 (20.75-48) months, there was a non-significant trend toward better recurrence-free survival in the NACRT group (57 vs 36 months, p-value - 0.831), with median overall survival yet to be achieved in both groups.

Compared with NACRT, NACT for ESCC is well tolerated and has non-inferior oncological outcomes. NACT could be a feasible alternative to NACRT in such patients, especially if the radiotherapy option is not feasible or available.