Safety and Outcome Analysis of Preoperative chemoradiation in Esophageal carcinoma

The incidence of esophageal cancer (EC) is increasing now-a-days and the management of EC has changed dramatically with the widespread adoption of mixed modality therapy. Although many Indian centres use combined modality therapy with neoadjuvant chemoradiation (nCRT), published data are scarce. This study assessed the feasibility of trimodality therapy in terms of safety and pathological complete response (pCR) among newly diagnosed patients with EC.

This ambispective study included the retrospective data of patients with locally advanced resectable carcinoma of the middle and lower thoracic oesophagus who were diagnosed and treated between January 2018 and December 2020 along with the prospective data of patients who were diagnosed between January 2021 and January 2023. The clinicodemographic details, radiation technique delivered along with the total dose planned, the dose received and chemotherapy details along with haematological toxicities and non-haematological toxicities were noted. The surgical details and aspects such as the interval between completion of neoadjuvant chemoradiation and surgery, postoperative mortality, pulmonary and cardiac complications, anastomotic leaks and length of hospital stay were recorded. The main outcome was the pCR of patients who received nCRT and underwent surgery.

Out of 250 cases retrieved, 100 eligible cases were included, in that, 50 patients received nCRT. About 84% of them underwent surgery after receiving nCRT and 30 patients (60%) post-surgery develop pCR. There were no grade 3 or 4 haematological toxicity noted and only few pateints developed non-haematological toxicities. Also, 16 patients developed postoperative complications. The median follow-up was 24 months, and the 1-year overall survival rate was 62 % among patients who received nCRT followed by surgery.

Neoadjuvant chemoradiotherapy followed by surgery was tolerable and safe in the majority of patients with locally advanced EC with lower incidence of Grade 3 and 4 haematological, non-haematological toxicity and post-surgical complications.