Trimodality treatment for locally advanced esophageal malignancies

Tarita Thomas; Maya Mathew; Nimra Elahi; Stephen Murata

doi:10.1200/jco.2016.34.4_suppl.174

174 Background: This study sought to review a single-institution experience with the management of patients with locally advanced esophageal adenocarcinoma, focusing on outcome and patterns of failure and factors affecting failure. Methods: A retrospective review of patients with locally advanced esophageal malignancies who were treated at our institution from 2002 to 2014. All patients underwent concurrent chemoradiation and surgery. Radiotherapy was delivered using 3-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT). Locoregional failure-free survival (LRFFS), distal metastasis free survival (DMFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Different factors which can affect the failure pattern were compared. Results: A total of 46 patients were analyzed. Median age was 66 years (range, 44 to 80 years). Forty three patients (93%) were men. All patients had adenocarcinoma (46% with moderately differentiated & 54% with poorly differentiated histology) involving the distal third of the esophagus. Ninety three percent were treated with 3DCRT while 7% received IMRT with a median dose of 50.4 Gy. 72 % of the tumors were downgraded after the neoadjuvant therapy, with 43 % complete response. With a median follow-up time of 22 months (range, 1 to 116 months), locoregional failure was observed in 10 patients (21%) and distant metastasis in 18 patients (39%). Among the 32 patients who died 16 patients died of disease progression and 6 patients died of post-operative complications. BMI (Body mass index) at the time of diagnosis, time elapsed between chemoradiation and surgery, history of weight loss at presentation and insertion of the J tube before neoadjuvant therapy did not affect the outcomes as per our study. Conclusions: Thoughneoadjuvant chemoradiation followed by surgery produces good pathological response to locally advanced esophageal malignancies, those results are not extrapolated to survival rates with most of the patients dying of distant metastasis. Further multi-institutional studies are required to assess other factors which are affecting the survival of esophageal cancer patients.

Trimodality treatment for locally advanced esophageal malignancies

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