Kundan Singh Chufal
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; Gairola, Munish
Dr Ram Bajpai email@example.com
Alexis Andrew Miller
Rahul Lal Chowdhary
Muhammed Ismail Sharief
Anjali Kakria Pahuja
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: 19.6–8), 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.
|Journal Article Type||Article|
|Acceptance Date||Dec 8, 2022|
|Online Publication Date||Jan 12, 2023|
|Publication Date||Feb 1, 2023|
|Publicly Available Date||Jan 13, 2024|
|Journal||BRITISH JOURNAL OF RADIOLOGY|
|Publisher||British Institute of Radiology|
|Article Number||ARTN 20220413|
This file is under embargo until Jan 13, 2024 due to copyright restrictions.
You might also like
In Regard to Park et al.