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ALL ABOUT TIMING: OPTIMIZING SUGERY INTERVALS AFTER NEOADJUVANT THERAPY IN ESOPHAGEAL CANCER
Sarah Gerber
*, Dino Kröll, Martin D. Berger, Hossein Hemmatazad, Borbély Yves
Inselspital Universitatsspital Bern, Bern, BE, Switzerland
Introduction:The current standard of care for curative treatment of esophageal cancer (EC) consists of neoadjuvant (radio-) chemotherapy followed by resection. However, the interval between neoadjuvant therapy and esophagectomy has been widely debated. For radiochemotherapy following the CROSS protocol, guidelines recommend surgery within 4 to 6 weeks, and chemotherapy using the FLOT regimen suggests a similar timeline. These recommendations aim to balance tumor control with perioperative recovery. However, prolonged intervals may offer patients critical recovery time to improve nutritional and physical status before surgery. This study investigates whether extending the interval beyond 8 weeks affects oncologic outcomes, focusing on tumor response and survival.
Materials and Methods:We conducted a retrospective analysis of 184 patients with esophageal adeno or squamous cell cancer treated with neoadjuvant radiochemotherapy (adapted CROSS protocol) or chemotherapy (FLOT) between 2014 and 2022. Patients were categorized into three groups based on the interval from completion of neoadjuvant therapy to surgery: early (?8 weeks), intermediate (8–12 weeks), and late (>12 weeks). Outcomes included pathologic response (TNM/UICC staging) and overall survival (OS). Statistical analysis assessed differences between groups.
Results:Baseline characteristics, including demographic factors, tumor-related variables and neoadjuvant treatment were comparable across the early (n=41), intermediate (n=80), and late (n=63) groups.
Pathologic tumor response (downstaging based on TNM/UICC criteria) was similar among the groups, with no significant differences in rates of complete or partial response. Survival analysis also revealed no statistically significant differences in overall survival (OS) between the groups with a median OS of 39 months (24.7-53.3) in the early, 62 months (29.3-94.7) in the intermediate and 45 months (22.7-67.3) in the late group (p=0.253).
Notably, the intermediate group (8–12 weeks) showed a non-significant trend toward improved outcomes, with a slightly higher proportion of complete tumor regression and longer median OS compared to the early and late groups.
Discussion:This study supports the safety of delaying esophagectomy beyond the traditionally recommended 4–8 weeks, particularly in the intermediate interval of 8–12 weeks. Allowing additional time may enhance patient recovery and preoperative fitness without adversely affecting oncologic outcomes. Further prospective studies are needed to confirm these findings.
Figure 1: Overall survival of patients with esophageal cancer corresponding to the intervall between end of neoadjuvant therapy and surgery
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