ESMO Asia Congress 2022

Abstract 129P

Background

Paclitaxel and carboplatin-based weekly chemotherapy with concurrent RT has been the standard of care after the results of the CROSS trial. This regimen is now being used in all the settings of carcinoma esophagus- radical or neoadjuvant. However, this trial had good selection criteria with most of the patients having good performance status. Hence, we conducted a study to evaluate the tolerance and outcome among all the patients diagnosed with carcinoma esophagus.

Methods

Retrospectively records of patients with carcinoma esophagus were included from January 2018- June 2022. Parameters such as demographic profile, tumor characteristics, radiation intent and doses, concurrent chemotherapy cycles and dose, associated toxicity, treatment outcome overall survival, and progression-free survival were analyzed.

Results

40 patients were identified with carcinoma esophagus who received CRT with weekly paclitaxel and carboplatin. The median age was 66 years, with a male: female ratio of 1.2:1. Most of the patients were having ECOG PS of 1. 47.5% of patients had mid-thoracic esophagus involvement. The median length of esophagus involvement was 5.4cm. All were squamous cell carcinoma with the most common differentiation being moderately differentiated. 50% of patients were T3, N1-2. 18 patients received neoadjuvant CRT and 22 received radical CRT. Radiation doses prescribed were 41.4-45 Gy in the neoadjuvant setting and 50.4-54 Gy in the radical setting. Pre-treatment 11 patients were on nutritional support in form of Ryle’s tube, feeding jejunostomy. During treatment, additional 10 patients required Ryle’s tube insertion. An average of 4 cycles of weekly chemotherapy was tolerated by the patients. Table: 129P

Characteristic	Number
Cause for fewer chemotherapy cyclesDecrease in performance status Neutropenia	53
Post neoadjuvant CTRT--> SurgeryYesNoMetastaticDefaultedInoperable--> Radical RTExpiredRefused further treatment	81021241
Pathological response post-surgeryComplete response Residual on pathology	62
Weight Loss during CRT (%)Median	6
Toxicity GradeNeutropenia≤ 2≥ 3Thrombocytopenia≤ 2≥ 3	144 51
Outcome (Median follow-up)Complete responseNeoadjuvantRadicalLocoregional progressionLocal recurrenceMetastasisExpiredDisease-relatedNot related to primary disease	218132131349
Median survival (months)Overall survivalProgression-free survival	21.120.7

Conclusions

Our study shows that in the Indian population the average number of weekly concurrent chemotherapy cycles tolerated is four, with neutropenia and a decrease in the performance status being the most common cause of poor tolerance after 4 cycles.