Preoperative Chemoradiotherapy for Esophageal Carcinoma: A Single-Center 10-Year Experience of Low Versus High-Dose Neoadjuvant Chemoradiation.

Abstract

Background: While neoadjuvant chemoradiotherapy (CRT) is considered the standard of care for patients with locally advanced esophageal or gastroesophageal junction (GEJ) cancer, the optimal radiation dosing remains undefined. We aimed to assess the perioperative and long-term outcomes comparing patients treated with low-dose (LD-RT) versus high-dose (HD-RT) radiation therapy.

Methods: Our institutional database was queried for patients with cT2-T4 or node-positive esophageal or GEJ cancer, who underwent surgery with neoadjuvant chemoradiation from 2010 through 2019. LD-RT and HD-RT regimens were defined as receiving total radiation dose ≤45 Gy and ≥50 Gy, respectively. Kaplan-Meier analysis, Cox proportional hazard modeling, and logistical regression were utilized for statistical analysis.

Results: A total of 287 patients were identified: 77 (27%) received LD-RT; 210 (73%) received HD-RT. Median follow-up from diagnosis to death or last contact was 37.1 months for the study cohort. Older age at diagnosis (odds ratio [OR] 1.03/year, p = 0.02) and year of diagnosis (OR 0.77/year, p < 0.001) were independently associated with receipt of HD-RT relative to LD-RT. Compared with HD-RT, LD-RT was associated with improved 5 year overall survival (OS; 55.1 vs. 44.1%, p = 0.03). On multivariate hazard modeling, receipt of HD-RT was independently associated with worse OS (hazard ratio [HR] 1.79, 95% 1.19-2.68, p = 0.005), disease-free survival (HR 1.78, 95% CI 1.09-2.88, p = 0.02), and recurrence-free survival (HR 1.68, 95% CI 1.11-2.55, p = 0.01) compared with those treated with LD-RT.

Conclusions: Despite less frequent utilization than HD-RT strategies, LD-RT is associated with improved survival in those treated with neoadjuvant CRT for esophageal or GEJ cancer.