Neoadjuvant or Definitive Chemoradiation for Locoregional Esophageal Cancer and its Outcome at South Egypt Cancer Institute (Retrospective Study)

Abstract
Background: It is well known about esophageal carcinoma, the aggressive and invasive nature, in addition to the poor outcome. The experience of south Egypt cancer institute was to review the locally advanced esophageal carcinoma, treated by chemo radiation either followed by surgery or not, and their outcome.
Aim of Study: In this study, we evaluate the efficacy of chemoradiation as a definitive or preoperative treatment.
Patients and Methods: During the period June 2008, till June 2014, 55 patients with locally advanced esophageal cancer were reviewed for treatment with preoperative or definitive concurrent chemo radiation, at Radiation Oncology Department, South Egypt Cancer Institute, Assiut University. Statistical analysis of data was done by the statistical package for the social science (SPSS) version 20.
Results: Out of 55 patients, 26 patients were included for definitive chemo radiation (dCRT). And 29 patients were included for neoadjuvant chemo radiation (nCRT). Squamous cell carcinoma (SqCC) represented in 72.7% of patients. Patients had disease stage II and III (32.7% and 67.3%) respectively. Median total radiation dose was 50.4 Gy over 28 fractions. Cisplatin+Fluorouracil regimen was received by 30 (54.5%) patients, while Paclitaxel+Carboplatin regimen was received by 25 (45.5%) patients. Overall response (CR+PR) was observed in 34 (72.3%) patients, while disease progression occurred in 5 (10.6%) patients and 17% (8 patients) had stable disease. The disease stage at diagnosis was a significant factor affecting clinical response. Out of 29 patients at neoadjuvant group, 18 patients (62%) underwent surgery, without major postoperative complications. Complete patho-logical response (no residual cancer cells) was observed in 6 (33%) patients. Median OS for dCRT and nCRT was 21 and 39 months respectively, it was in favor for nCRT group with no statistical significance (p-value=0.20). Median PFS for dCRT and nCRT was 16 and 18 months respectively, with no statistical significance (p-value=0.363). Disease stage at diagnosis and clinical response after radiotherapy were very highly significant factors affecting patients' overall survival and disease progression survival (p-value=0.014). Overall grade  ³3 toxicity 26 events was observed in 16 (29.0%) of the patients.
Conclusion: Neoadjuvant chemo radiation followed by surgery is considered as a standard care management for patients with resectable locally advanced esophageal carcinoma and fit for surgery. For patients with inoperable disease or unfit for surgery, definitive chemo radiation is accepted treatment option. The used chemotherapy regimens, Cispla-tin/Fluorouracil and Paclitaxel/Carboplatin, are tolerable in most patients with acceptable toxicity profile; and with no differences between two regimens.