P-044 - Preoperative chemoradiotherapy in locally advanced esophageal carcinoma. A retrospective study from a multidisciplinary oncologic centre

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Oesophageal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter M. Saigí
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors M. Saigí1, M. Oliva2, Ò. Serra3, L. Farran4, M. Calvo4, A.M. Boladeras5, G. Hormigo5, H. Aranda5, J. Robles6, J.B. Gornals7, E. de Lama6, M.J. Paúles4, N. Virgili6, F.J. Pérez Martín8, M. Galán4
  • 1Interdisciplinary Committee of Esophagogastric Tumours, Institut Català d'Oncologia (ICO), L'Hospitalet, IDIBELL, Hospitalet de Llobregat, Llobregat/ES
  • 2Interdisciplinary Committee Of Esophagogastric Tumours, Hospitalet de Llobregat, Llobregat/ES
  • 3Interdisciplinary Committee Of Esophagogastric Tumours, L'Hospitalet, IDIBELL, Sant Joan Despí, Llobregat/ES
  • 4Interdisciplinary Committee Of Esophagogastric Tumours, Institut Català D'oncologia (ico), Hospitalet de Llobregat, Llobregat/ES
  • 5Hospitalet De Llobregat, Interdisciplinary Committee of Esophagogastric Tumours, Institut Català d'Oncologia (ICO), Llobregat/ES
  • 6Hospitalet De Llobregat, Hospital Universitari Bellvitge (HUB), Llobregat/ES
  • 7Inerdisciplinary Committee Of Esophagogastric Tumours, Hospital Universitari Bellvitge (hub), Hospitalet de Llobregat, Llobregat/ES
  • 8Hospitalet De Llobregat, IDIBELL, Llobregat/ES

Abstract

Introduction

Neoadjuvant chemoradiotherapy (NA CRT) has shown benefit in overall survival (OS) in patients with locally advanced esophageal carcinoma. However, toxicity and postoperative morbidity are not negligible.

Methods

We retrospectively reviewed patients with locally advanced esophageal carcinoma treated at Catalan Institute of Oncology and integrated centers who underwent NA CRT from 2009 to 2013. G3/4 toxicity and postoperative complications were recorded. OS and disease free survival (DFS) curves and medians were performed by using Kaplan Meier method as well as identification of prognostic factors using multivariate Cox regression.

Results

61 pts were studied: median age 61 (34-75); 90% male; 97% PS ≤ 1, 3% PS2; 20% Barrett esophagus; 51% adenocarcinoma (ADC)/ 49% squamous cell carcinoma (SCC). Location: 82% esophagus, 18% esophagogastric junction (Siewert I or II). Clinical stage included cT2N + , cT3-4a N0/+. 95% were node positive (cN+). 90% pts received 2 cycles of NA CT, being the most used regimen CDDP-5FU (87%). Total RT dose received was 45 Gy (75%) and 50,4 Gy (25%), depending on the centre protocol. G3/G4 toxicity occurred in 9% pts (5% nonhematologic, 4% hematologic). Treatment radiological response was assessed by PET: 16% complete response, 56% partial response, 20% stable disease, 8% progression.

51 pts (84%) underwent surgery, 88% R0. Pathologic complete response (ypT0N0) was achieved in 12 pts (24%): 15% of resected ADC, 30% of SCC, ypN+ 38%. Deaths due to post-operative complications (within 30 days) occurred in 2 patients (4%). Overall recurrence rate (ORR) of pts who underwent surgery was 43% (54% of resected ADC, 32% of SCC). 25% pts had distant recurrence (DR), 8% locoregional recurrence (LR), and 10% synchronic DR and LR.

After a median follow-up of 18 months (m), median OS was 31,2 m (IC 95% 20,9-41,5): 22,4m ADC vs 39,7m SCC (p < .38). 1 and 2 years overall survival rate were 76,9% and 53,7%, respectively. mDFS was 17m (IC 95% 12-22): ADC 13m vs SCC 18m (p <.29). In the multivariate Cox regression, two independent factors influenced positively in OS: R0 (p< .001) and PS ≤ 1 (p< .012).

Conclusion

NA CRT is a safe strategy for locally advanced esophageal carcinoma in selected pts, who have been treated with multidisciplinary approach. It improves R0 rate and tumor downstaging with similar results than previous reports. ADC and SCC represent two distinct diseases with different epidemiology and prognosis. However, no significant differences were achieved in our cohort probably due to small number of pts.