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BACKGROUND: Neoadjuvant chemoradiotherapy followed by surgery has become standard of care at most of the centres.
OBJECTIVE: To assess the impact of Neoadjuvant chemoradiotherapy on survival in patients with locally advanced carcinoma esophagus.
MATERIALS AND METHODS: From our prospectively maintained database, we retrospectively reviewed all patients who underwent Neoadjuvant chemoradiotherapy for resectable esophageal cancer between November 1999 and December 2010. RESULTS: Out of total 188 patients with carcinoma esophagus, 117 patients underwent Neoadjuvant chemoradiotherapy (NACRT).104 patients had squamous cell carcinoma (SCC) and 13 patients had adenocarcinoma (ADC). 15(12.8%) patients developed complications on CRT and 4 (3.4%) patients died as a consequence of complications. Out of all the patients who underwent NACRT, 22 patients did not undergo surgery (4 deaths on CRT, two had progression of disease, 7 patients were not willing for surgery, 9 patients were lost to follow up). Mean interval between NACRT and surgery was 44.36days. 95 patients underwent surgery with curative intent [82 underwent Transhiatal esophagectomy, 7 underwent Tran thoracic esophagectomy, 6 underwent open assessment and closure for intrabdominal metastatic disease. On assessing final histopathology of all patients who underwent curative resection, we found complete pathological response (pCR) to NACRT in 18(18.9%) and 75(64.1%) had partial response. No patient with adenocarcinoma had pCR. Overall survival in these patients who underwent Neoadjuvant chemoradiotherapy and subsequently surgery was 65.4% at 1 yr, 28.7% at 3 yr, 19.1% in 5yrs. 11 patients are still alive at the time of analysis of our data. Out of 87 patients, 62 patients were on regular follow up. Disease free survival (DFS) in these patients was 53.2% at 1 yr, 19.4% at 3yr, 12.9% at 5yr (Mean 26.87months and median was 13 months).On analyzing factors affecting survival; only those patients who had complete pathological response to NACRT had statistically significant survival compared to patients who had no response or partial response to NACRT (DFS median 21 months vs. 12months, p-0.019). Out of 62 patients who were on regular follow up, 51(43.6%) had documented recurrence before death with most common site of recurrence being lung
CONCLSION-With NACRT we could achieve mean survival of 33 ± 5.39 months in carcinoma esophagus. 12% of patients developed complications of NACRT. Patient with complete pathological response and smaller lesions were found to have better survival by multivariate analysis