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Utility of Radiation After Neoadjuvant Chemotherapy for Surgically Resectable Esophageal Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Neoadjuvant chemotherapy (NAC) ± radiation (NRT) is the “gold standard” approach for locally advanced esophageal cancer (EC). However, the benefits of RT on overall survival (OS) in patients with resectable EC undergoing neoadjuvant therapy followed by esophagectomy remain controversial.

Methods

The National Cancer Data Base was queried for patients with nonmetastatic EC between 2004 and 2014. Kaplan–Meier, log-rank, and Cox multivariable regression analysis were performed to analyze OS. Logistic regression analyzed factors associated with 90-day mortality, lymph node involvement, and complete pathological response (pCR).

Results

A total of 12,238 EC patients who underwent neoadjuvant therapy [neoadjuvant chemoradiation (NACR), 92.1% and NAC, 7.9%] followed by esophagectomy were included. OS was similar in patients undergoing NAC ± RT (35.9 vs. 37.6 mo, respectively, p = 0.393). pCR rate was 18.1% (19.2%, NACR vs. 6.3%, NAC, p < 0.001). NRT was an independent predictor for increased pCR (HR 2.593, p < 0.001). Patients with pCR had increased survival compared with those without pCR (62.3 vs. 34.4 mo, p < 0.001); however, no difference was found between NACR and NAC (61.7 mo vs. median not reached, p = 0.745) in pCR patients. In non-pCR patients, NAC had improved OS compared with NACR (37.3 vs. 30.8 mo, p = 0.002). NRT was associated with worse 90-day mortality (8.2% vs. 7.7%, HR1.872, p = 0.036) In Cox regression, NRT was an independent predictor of worse OS (HR 1.561, p < 0.001).

Conclusions

Neoadjuvant RT is associated with improved pCR rates; however, it had deleterious effects in short- and long-term survival. Also, patients who did not achieve pCR had worse OS after neoadjuvant RT.

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Authors and Affiliations

  1. Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, FL, USA

    Francis I. Macedo MD

  2. Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA

    Jose Wilson Mesquita-Neto MD

  3. Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA

    Kristin N. Kelly MD, MPH, Nipun B. Merchant MD, Alan S. Livingstone MD & Dido Franceschi MD

  4. Sentara Careplex Hospital, Sentara Healthcare System, Hampton, VA, USA

    Basem Azab MD

  5. Department of Surgery, University of Tennessee School of Medicine, Memphis, TN, USA

    Danny Yakoub MD

Authors
  1. Francis I. Macedo MD
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  2. Jose Wilson Mesquita-Neto MD
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Supplementary material 1 (DOCX 76 kb)

Figure S1. Flow chart depicting cohort selection (JPEG 75 kb)

10434_2019_7788_MOESM3_ESM.jpg

Figure S2. Kaplan–Meier curves depicting overall survival in patients undergoing NACR or NAC according to pathological tumor stage. In patients with pT2, median OS was statistically superior in patients undergoing NAC compared to NACR (60.9 vs. 35.9 months, p = 0.002). For all remaining pathological T stages, there was similar OS between NAC and NACR (pT0: not reached vs. 53.9 months, p = 0.489; pT1: 62.7 vs. 45.8 months, p = 0.099; pT3: 26.1 vs. 25.3 months, p = 0.385 and pT4: 21.1 vs. 18.2 months, p = 0.066) (JPEG 822 kb)

10434_2019_7788_MOESM4_ESM.jpg

Figure S3. Kaplan–Meier Curves demonstrating similar overall survival in patients undergoing NACR or NAC according to histological type. A: Adenocarcinoma, NAC- 37.6 months vs. NACR- 35.5 months, p = 0.203). B: Squamous cell carcinoma: NAC-32.9 months vs. 40.7 months, p = 0.503 (JPEG 552 kb)

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Macedo, F.I., Mesquita-Neto, J.W., Kelly, K.N. et al. Utility of Radiation After Neoadjuvant Chemotherapy for Surgically Resectable Esophageal Cancer. Ann Surg Oncol 27, 662–670 (2020). https://doi.org/10.1245/s10434-019-07788-9

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  • DOI: https://doi.org/10.1245/s10434-019-07788-9

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