Abstract
Background: Esophageal cancer is the fourth most common cause of cancer-related deaths in India.
In 2012, the CROSS trial evaluated the benefit of induction therapy using weekly carboplatin-paclitaxel
with 41.4 Gy radiation versus surgery alone. Pathological complete response (pCR)
rates were 28%. Overall survival was improved in the combined therapy arm. However,
there is limited data regarding the outcomes of preoperative chemoradiation in Indian
scenario. This study was conducted to determine the response to preoperative chemoradiation
at a tertiary cancer center in India. Aims: Primary objective was to evaluate the rates of pCR. Secondary objective was to determine
recurrence rate and patterns of recurrence. Materials and Methods: We retrospectively reviewed patients with locally advanced esophageal cancer and
gastroesophageal junction treated from September 2013 to July 2015. Patients who received
preoperative radiotherapy 41.4 Gy with chemotherapy (weekly paclitaxel-carboplatin
or cisplatin-5 FU or cisplatin-capecitabine) were included in this study. Chi-square
test and Fischer's exact test were used for analysis. Results:: Fifty patients were included in the analysis (76% – squamous cell carcinoma [SCC]
and 24% – adenocarcinomas [ACC]). About 60% patients received weekly paclitaxel-carboplatin
(CROSS protocol), 32% cisplatin-5 FU, and 8% cisplatin-capecitabine. pCR rate was
39.6%. pCR rate was higher in SCC versus ACC (44.7% vs. 20%) and in paclitaxel-carboplatin
than cisplatin-5FU or cisplatin-capecitabine (48.3% vs. 25% vs. 33.3%). At a median
follow-up of 12 months, 38 patients were alive, 8 died, and 4 lost to follow-up. Of
the 10 patients that recurred, 8 were distant recurrences. Conclusion: Our study results show favorable pCR rate after preoperative CRT with significant
higher rate in SCC and patients receiving CROSS regimen. Majority of the recurrences
were distant recurrences.
Keywords
Carcinoma Esophagus - pathological complete response - preoperative chemoradiation
