Chemoradiation tied to greater tumour regression than chemotherapy in oesophageal cancer

Neoadjuvant chemoradiation (C-RT) for locally advanced oesophageal cancer (LAEC) results in a higher degree of pathologically tumour regression, a study has shown. Outcomes are better among patients with major tumour regression than those with minimal to poor response.

Additionally, a trend towards improved time to recurrence (TTR) with C-RT has been observed, but there is no difference in overall (OS) or recurrence-free survival (RFS).

The authors presented an institutional review and outcome of LAEC patients treated with neoadjuvant C-RT or perioperative chemotherapy (P-CT) followed by surgery. They identified these patients using the Manitoba Cancer Registry.

Proportion hazard regression analysis was conducted to compare OS, RFS, and TTR. Metabolic and pathologic response rates were also compared using the Fisher exact test.

Sixty-seven patients underwent C-RT and 32 received P-CT. More than half of these patients (52 percent) had pretreatment and post-treatment positron emission tomography scans prior to surgery.

Partial metabolic response or stable disease was noted in 95 percent of patients in the C-RT group and 91 percent in the P-CT group. Sixty-one percent of C-RT and 34 percent of P-CT patients had tumour regression grade (TRG) 0 to 1, while 39 percent of C-RT and 66 percent P-CT had TRG 2 to 3 (p=0.018).

Median OS was 37 months for patients with TRG 0 to 1 and 18 months for those with TRG 2 to 3 (hazard ratio [HR], 1.96, p=0.013). Three-year OS was 43 percent vs 37 percent (HR, 1.30; p=0.37), RFS was 34 percent vs 26 percent (HR, 0.96; p=0.87), and median TTR was 30 vs 13 months (HR, 0.59; p=0.07) for C-RT and P-CT, respectively.

“P-CT or neoadjuvant C-RT followed by surgical resection is the standard of care for LAEC,” the authors said.