Abstract 414P
Background
Neoadjuvant chemoradiotherapy is superior to neoadjuvant chemotherapy alone because it combines strong local and systemic treatment, improves R-0 resection rates, and leads to a higher pathological complete response (PCR) rate.
Methods
Patients with histologically proven SCC of the oesophagus were treated between January 2019 and July 2023. We administered paclitaxel- carboplatin and RT simultaneously as per cross-protocol. Harmful effects assessed using the CTCAE version 4.0.
Results
421 cases of carcinoma of the oesophagus were diagnosed, of which 412 were squamous, 47 were eligible for the CROSS, and 46 were analyzed. CTCAE neutropenia - 25.9%, thrombocytopenia - 4.4%.No surgical complications - 76% (n=35), Sx complications - 24% (n=11); Anastomotic leak - 12.7% (n=6), sepsis - 4.3%, pneumonia - 4.3%, vocal cord palsy - 2.1%. Modified RyanTRG - 0 (PCR) - 55.3% (n=26); Lymphovascular Invasion (LVI) - 14.9%, perineural Invasion (PNI) - 10.6%. Patients who had no LVI (p=0.002) and PNI (p=0.015), low TRG Ryan (p=0.001), and Mandrad (p=0.024) are independent risk factors of survival outcome. Out of 46: alive - 40.4% (n=19); loss of follow-up - 36.2% (n=17); 6 deaths: 50%(n=3) due to anastomotic leak; 33.3% - pneumonia, 16.6%,- sepsis; 8.5% (n=4) - recurrence. For a median follow-up of 20 months(m), the median progression-free survival (PFS) is 17 months (IQR: 4–29.5m), mPFS who achieved PCR - 19 months (8–32m); those who did not achieve PCR - 8 months (1.9–22) (p = 0.052). Overall, 1 year(yr) PFS - 54.3%; 2 yr PFS - 30.43%; 3 yr PFS - 15%. 1 yr PFS in PCR - 64%; 2 yr PFS - 44%; 3 yr - 20%. For a median follow-up of 20 months, the median overall survival (OS) is 16 months (IQR: 8.6-32.5m). The mOS with PCR is 25 months (IQR: 13–37m); without PCR - 11 months (IQR: 23 m) (p = 0.026). Overall OS at 1 yr - 65.2% (95%CI: 49.6-77.0%); 2 yr - 39.1% (25.2-52.7%); 3 yr - 21.7% (11.2-34.4%).1 yr OS in PCR - 80% (58.4–91.1%); 2 yr OS - 52.0% (31.2–69.2%); 3 yr OS 32% (15.2–50.1%).
Conclusions
In the Indian population, squamous histology is still common, and the CROSS protocol is practised in many centres in India. Patients who achieve PCR can forego adjuvant immunotherapy. The CROSS protocol can be safely administered in resource-poor settings where immunotherapy is still out of reach for many patients.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.