Induction Radiochemotherapy for Esophageal Cancer: Long-Term Outcomes from a Single-Center Study.

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Esophageal cancer (EC) management presents challenges in optimizing treatment strategies.
• Preoperative radiochemotherapy (CRT) is a key component in multimodal EC treatment.
• Identifying subgroups benefiting from definitive CRT (dCRT) is crucial for personalized care.

Purpose of the Study:

• To evaluate the impact of preoperative CRT on clinical staging in EC patients.
• To identify patient subgroups for whom dCRT might be a favorable alternative to surgery.
• To assess oncologic control with dCRT in patients who declined surgery.

Main Methods:

• Sixty-one EC patients received preoperative CRT (CROSS or dCRT protocols).
• Staging involved CT, gastroscopy, and laboratory evaluations; surgery included esophagectomy or Ivor Lewis procedures.
• Four patients received dCRT instead of surgery; outcomes assessed via pTNM and follow-up.

Main Results:

• Preoperative CRT significantly reduced T stage (p=0.0002) with a 54.5% complete pathological response rate (pT0N0M0).
• Male patients showed a significant T stage reduction (p=0.0008).
• dCRT provided acceptable oncologic control in non-surgical candidates over 4 years.

Conclusions:

• Preoperative CRT effectively downstages EC and yields high response rates, especially in males.
• dCRT is a potential alternative to surgery for selected EC patients.
• Individualized treatment strategies and refined multimodal approaches are essential for optimizing EC care.