A comparison of staged and concurrent neo-adjuvant chemoradiotherapy in resectable locally advanced oesophageal carcinoma.

Introduction: Oesophageal cancer is the eighth most common cancer and sixth most common cause of death from cancer worldwide. Current overall five-year survival rates are at best 10%, largely due to the advanced stage of disease at presentation. Systemic disease requires systemic therapy, and thus the standard of care is neo-adjuvant chemoradiotherapy followed by surgery for the vast majority of patients.

Aims: The aim of this retrospective study was to determine overall survival following two neo-adjuvant chemoradiotherapy regimes in patients undergoing multi-modal therapy (including oesophagectomy) for oesophageal carcinoma.

Methods: One hundred and nine consecutive patients treated with neo-adjuvant chemoradiotherapy for oesophageal carcinoma between 2001 and 2011 were divided into two groups: 24/109 (22%) patients who underwent single-cycle induction chemotherapy followed by neo-adjuvant chemoradiotherapy and surgery (‘chemo-first’), and 85/109 (78%) who received concomitant neo-adjuvant chemoradiotherapy, followed by consolidation neo-adjuvant chemotherapy (‘CR-C’ group) prior to surgery. All 109 patients were followed up until the date of death or last clinical interaction. Follow-up and cause of death, if applicable, was determined by review of patient records.

Results: Mean overall survival time for all patients was 50.9 (±7) months; 50.3 (±10) months for ‘chemo-first’ patients versus 43.1 (±7) months for ‘CR-C’ patients (p=0.080). Significantly higher rates of acute treatment-associated toxicity were seen in the ‘chemo-first’ patients (4/24, 16.67%) vs. the ‘CR-C’ patients (2/85, 2.3%) (p=0.001).

Conclusion: There was no statistically significant difference in overall survival between the two groups. The ‘chemo-first’ treatment regime resulted in a greater number of treatment-related toxicities when compared with CR-C.