Tri- modality therapy in advanced esophageal carcinoma: long- term results and insights from a developing world, institutional cohort

Chufal, Kundan Singh; Ahmad, Irfan; Bajpai, Ram; Miller, Alexis Andrew; Chowdhary, Rahul Lal; Makker, Jasbir; Batra, Ullas; Nathany, Shrinidhi; Sharief, Muhammed Ismail; Umesh, Preetha; Sharma, Mansi; Amrith, Patel; Pahuja, Anjali Kakria; Sethi, Jaskaran; Antony, Varghese; Gairola, Munish

Abstract

Objective: To evaluate treatment outcomes in patients from a low-middle income country (LMIC) with esophageal carcinoma who underwent esophagectomy after neoadjuvant chemoradiation (NACRT/S). Methods: Between 2010 and 2020, 254 patients (median follow-up: 53 months) met our inclusion criteria. Out-of-field nodal regions were determined by reviewing individual radiotherapy plans. Cox regression modelling was performed to analyze overall survival (OS) and recurrence-free survival (RFS), while pathological complete response (pCR) prediction utilized Poisson regression. Results: The median OS was 71.4 months (interquartile range: 19.6–∞), RFS did not reach the median and pCR rate was 46%. On multivariable Cox regression, BMI [0.93 (0.89–0.98); 0.94 (0.89–0.99)] and absence of out-of-field node with extranodal extension (ENE)[0.22 (0.09–0.53); 0.30 (0.12–0.75)] influenced OS and RFS, respectively. Age [1.03 (1.01–1.06)], nodal stage [cN2-3 vs cN0: 2.67 (1.08–6.57)] and adventitial involvement [2.54 (1.36–4.72)] also influenced OS, while involved margins [3.12 (1.24–7.81)] influenced RFS. On multivariable Poisson regression, non-CROSS-chemotherapy regimens [0.65 (0.44–0.95)] and residual primary disease on pre-surgical imaging [0.73 (0.57–0.93)] were significantly associated with pCR. The most frequently involved in-field and out-of-field nodal regions were the periesophageal and perigastric (greater and lesser curvature) regions, respectively. Conclusion: NACRT/S is feasible and effective in patients from LMIC. Out-of-field ENE merits further investigation as a prognostic factor since it significantly influenced both OS and RFS. Advances in knowledge: The results of clinical trials are replicable in LMICs. Out-of-field ENE is an independent prognostic factor for OS and RFS.

Citation

Chufal, K. S., Ahmad, I., Bajpai, R., Miller, A. A., Chowdhary, R. L., Makker, J., …Gairola, M. (2023). Tri- modality therapy in advanced esophageal carcinoma: long- term results and insights from a developing world, institutional cohort. British Journal of Radiology, 96(1143), Article ARTN 20220413. https://doi.org/10.1259/bjr.20220413

• Journal Article Type: Article
• Acceptance Date: Dec 8, 2022
• Online Publication Date: Jan 12, 2023
• Publication Date: Mar 1, 2023
• Publicly Available Date: Jan 13, 2024
• Journal: The British Journal of Radiology
• Print ISSN: 0007-1285
• Publisher: British Institute of Radiology
• Volume: 96
• Issue: 1143
• Article Number: ARTN 20220413
• DOI: https://doi.org/10.1259/bjr.20220413
• Keywords: Radiology, Nuclear Medicine and imaging, General Medicine
• Publisher URL: https://www.birpublications.org/doi/epub/10.1259/bjr.20220413