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. 2022 Jul 29;27(3):500-508.
doi: 10.5603/RPOR.a2022.0054. eCollection 2022.

Dose-escalated neoadjuvant chemoradiotherapy for locally advanced oesophageal or oesophagogastric junctional adenocarcinoma

Victor Duque-Santana  1 , Fernando López-Campos  1 , Margarita Martin  1 , Lira Pelari  1 , Antonio Hernandez  1 , Mireia Valero  1 , Julio Galindo  2 , Pablo Priego  2 , Marta Cuadrado  2 , Federico Longo  3 , María Caminoa-Lizarralde  4 , Sonsoles Sancho  1
Affiliations

Dose-escalated neoadjuvant chemoradiotherapy for locally advanced oesophageal or oesophagogastric junctional adenocarcinoma

Victor Duque-Santana et al. Rep Pract Oncol Radiother. .

Abstract

Background: Neoadjuvant chemoradiotherapy with CROSS-protocol is the standard of care for locally advanced esophageal cancer. The purpose of this study was to demonstrate an improvement in complete pathological response (ypCR) after a dose-escalation neoadjuvant protocol compared to standard treatment. Secondary endpoints were disease-free survival (DFS) and acute gastrointestinal toxicity.

Material and methods: We prospectively evaluated patients with locally advanced esophageal adenocarcinoma who received neoadjuvant chemoradiotherapy. The radiation dose was 41.4 Gy in 23 fractions or 50.4 Gy in 28 fractions with weekly administration of six intravenous cycles of carboplatin AUC 2 mg/mL and intravenous paclitaxel 50 mg/m2 followed by surgery.

Results: Between December 2015 and July 2020, 21 patients were treated according to the reported radiation schedules. Median age was 61 years (57-67). 20 (95.2%) tumors were located at the esophagogastric junction and 1 (4.8%) in the middle esophagus. Five (23.8%) were stage II and 16 (76.2%) stage III. Twelve (57.1%) patients received 41.4 Gy (standard group) and 9 (42.9%) received 50.4 Gy (intensification group), with 5 (41.67%) and 5 (55.6%) presenting ypCR in the standard and intensification group, respectively (p = 0.67). After a median follow-up of 17 months (8-30), DFS in the standard group was 17.78 months [95% (CI, confidence interval): 12.9-22.6] and 45.5 months (95% CI: 24.4-66.05) in the intensification group (p = 0.299). Grade III acute gastrointestinal toxicity was 16% and 33.33%, respectively (p = 0.552). Postoperative toxicity events ≥ Grade III were 5 (41.7%) and 4 (44.4%), respectively (p = 0.623).

Conclusions: In our study we found a trend towards a higher complete pathological response-rate and disease-free survival in the intensification group compared to the standard group, with no differences in gastrointestinal toxicity. Well-designed randomized and controlled trials are needed to obtain conclusive data.

Keywords: chemoradiotherapy; dose-escalated radiotherapy; esophagogastric adenocarcinoma; intensity-modulated radiotherapy.

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Conflict of interest statement

Conflicts of interest There are no conflicts of interest of any of the authors

Figures

Figure 1
Figure 1
Tumour regression grading in both treatment groups
Figure 2
Figure 2
Kaplan-Meier curves of disease-free survival (DFS) in both groups
See this image and copyright information in PMC

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