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A REAL WORLD EXPERIENCE IN TREATING ESOPHAGEAL CANCER: PATHOLOGIC RESPONSE TO NEOADJUVANT CHEMORADIOTHERAPY
Lily B. Hsieh^*, Edward Cho, Katie Miller, Ramesh Ghanta, Houssam Osman, D Rohan Jeyarajah
Surgery, Methodist Health System, Garland, TX
Introduction: Since the CROSS trial, multi-modal neoadjuvant therapy for locally advanced esophageal cancer has become the standard. The purpose of our study is to evaluate our pathologic outcomes in treating patients with esophageal cancer at a non-university tertiary healthcare center outside of the clinical trial setting.
Methods: This is a retrospective study of patients with esophageal cancer, either squamous cell or adenocarcinoma, from February 2013 to July 2017 who underwent neoadjuvant chemotherapy +/- radiation and subsequent transhiatal esophagectomy. Pathologic response and complete resection (R0) were analyzed for these patients.
Results: From February 2013 to July 2017, there were 56 patients with a diagnosis of high-grade dysplasia, adenocarcinoma, or squamous cell carcinoma of the esophagus that underwent transhiatal esophagectomy. 6/56(10.7%) had T1 or less lesions that did not require neoadjuvant therapy. 43 patients that could be accurately staged pre-operatively also underwent neoadjuvant chemoradiotherapy. 22/43(51.2%) who received neoadjuvant chemoradiation were down-staged and 36/43(83.7%) had R0 resection. Complete pathologic response was achieved in 5/43(11.6%) of these patients.
Conclusion: While our R0 resection and complete pathologic response rates are not as high as those reported in the CROSS trial, we believe that with time as neoadjuvant multi-modal therapy becomes more uniform, we will be able to achieve similar results for our esophageal patients in "real world" practice.

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