PREOPERATIVE CHEMORADIOTHERAPY FOR ESOPHAGEAL CARCINOMA: A SINGLE CENTER 10-YEAR OUTCOMES OF CROSS VS MODIFIED CROSS RADIATION.
Mohamed Elsheikh*, Yeon Jung Yoo, Thomas L. Sutton, Stephanie G. Wood
Oregon Health & Science University, Portland, OR
Introduction
Esophageal cancer carries significant disease burden with rising incidence in high-income countries. Recent trials have proven significant survival benefit with neoadjuvant chemoradiation followed by surgery, with the CROSS trial in particular showing 47% 5-year survival and 29% pathologic Complete Response (pCR). The CROSS-trial patients received 41.4 Gy radiation, yet many centers utilize 50/50.4 Gy radiation either routinely or in selective cases. In our study, we aim to determine if 41.4 Gy vs >41.4 Gy radiation impacts minimally invasive esophagectomy (MIE) complications and oncologic outcomes.
Methods
This is a single-center retrospective review of an institutional registry database and the electronic medical record. Patients over the age of 18 with advanced (cT2–cT4 or node-positive) esophageal or gastroesophageal junction carcinoma who underwent neoadjuvant chemoradiotherapy followed by esophagectomy between January 1, 2010 and December 31, 2019 were included. Patient demographics, imaging, treatment, postoperative complications, and tumor response characteristics were analyzed and compared between 41.4 Gy and >41.4 Gy radiation groups. SPSS was used to analyze the data.
Results
This study included 305 patients (Table 1). Majority of the patients were males (83.6%), with a diagnosis of adenocarcinoma (87.2%), and a median age of 65. The median oncologic follow-up time was 37 months from time of diagnosis. Our findings showed no association between radiation dose group (41.4 Gy vs. >41.4 Gy) and cumulative post-operative complication (OR 1.03, 95% CI 0.513-2.068, p=0.94). Furthermore, there was no difference in the pCR rate (OR 0.59, 95% CI 0.24-1.47, p=0.26), even when controlling for higher stage cancer (T>2 or N+ disease). There was a nonsignificant trend toward a higher rate of positive R1 margins (12.5% vs 5.3%, p=0.09) in the 41.4 Gy group. However, there was a significant increase in overall survival in the 41.4 Gy group (HR 0.47, 95% CI 0.25-0.87, P=0.02) after excluding patients with pCR. In addition, the 41.4 Gy group had significant recurrence-free survival compared to the higher radiation dose group (Figure 1).
Discussion
Interestingly, the 41.4 Gy radiation dose group yielded similarly pCR and better overall and recurrence-free survival with comparable peri-operative complication rates to higher radiation doses >41.4 Gy. These results suggest that neoadjuvant CROSS 41.4 Gy radiation dosing has equivalent, if not superior, oncologic outcomes to higher dose modified CROSS radiation for esophageal cancer. Although a more controlled study is warranted to rule out confounders and minimize selection bias.
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