94P - The treatment burden of neoadjuvant carboplatin/paclitaxel versus 5-fluorouracil/cisplatin in combination with radiotherapy for patients with esophageal cancer

Background

Both neoadjuvant carboplatin/paclitaxel (CROSS) and cisplatin/5-fluorouracil (PF) regimens in combination with radiotherapy are significantly effective at improving survival in patients with esophageal cancer. However, the treatment burden differ greatly among the two strategies.

Methods

Our goal is to select the most beneficial neoadjuvant chemoradiotherapy (nCRT) regimen for esophageal squamous cell carcinoma (ESCC) in terms of in- and outpatient visits, adverse events, medical costs and survival outcomes. Both regimens are, by intention, given in an outpatient setting.

Results

From 2012-2020, 232 patients eligible for nCRT were retrospectively collected from two Taiwanese medical centers, 153 patients received CROSS and 79 received PF, the intended radiotherapy dose was 41.4Gy-45Gy. The two groups were comparable in tumor and patient characteristics except for patient’s age (mean age =58.6 ± 8.7 in the CROSS group vs 54.8 ±8.5 in the PF group; P<0.001). More than 80% had clinical stage III or IVa disease. The nCRT completion rates were comparable. Patients in the PF group experienced more nausea, vomiting, diarrhea and dysphagia during nCRT. They lost an average of 4% of body weight after nCRT compared to 1% in the CROSS group (P=0.001). However, patients who received CROSS experienced more lymphocytopenia and leukopenia (P<0.001). Only 20% of all patients in the PF group were never admitted compared to 70% in the CROSS group (P<0.001). Despite the higher costs of chemotherapeutic agents of the CROSS regimen, the two groups had comparable cost expenditures during nCRT. Three-year overall and progression free survival were 48% vs 46% (P=0.39) and 31% vs 20% (P=0.042), in the CROSS and PF group, respectively.

Conclusions

The treatment burden of nCRT according to the CROSS regimen on patients with esophageal cancer was significantly less than the PF regimen.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.