Surgical outcomes of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy in patients of locally advanced carcinoma of esophagus: A prospective cross-sectional comparative study

Authors

  • Rohit Kumar Jha Assistant Professor, Department of Surgical Oncology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India https://orcid.org/0009-0003-1650-449X
  • Shalini Kumari Senior Resident, Department of ENT and HNS, Shaheed Nirmal Mahto Medical College, Dhanbad, Jharkhand, India https://orcid.org/0009-0002-9435-6069
  • Sumedha Gargy Senior Resident Department of Surgical Oncology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India https://orcid.org/0000-0001-5960-5600
  • Rajen A Tankshali Retired Professor, Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
  • Kiran C Kothari Retired Professor, Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India https://orcid.org/0000-0003-2930-5142

DOI:

https://doi.org/10.3126/ajms.v15i2.58705

Keywords:

Esophageal carcinoma; Neoadjuvant; Chemoradiotherapy; Chemotherapy; Paclitaxel; Carboplatin

Abstract

Background: Neoadjuvant chemoradiotherapy + radiotherapy (NACT+RT) or neoadjuvant chemotherapy (NACT) has been shown to improve survival in locally advanced esophageal carcinoma (EC). Comparative evaluation of NACT+RT versus NACT is ambiguous.

Aims and Objectives: The current study was designed to evaluate the outcomes of NACT+RT versus NACT in locally advanced EC.

Materials and Methods: In this prospective cross-sectional study, patients with operable, non-metastatic squamous cell carcinoma, and adenocarcinoma of the mid and lower esophagus (T3–T4a) were treated with NACT (paclitaxel 175 mg/m2 plus carboplatin 5 Area under curve (AUC) every 3 weeks) or NACT+RT (NACT with 45 Gy in 25 fractions over 5 weeks). Response, R0 resections, post-operative complications, and recurrence were comparatively evaluated.

Results: Of 40 enrolled patients, 20 received NACT and 20 received NACT+RT. In the NACT arm, 50% of patients had a partial response and 20% had disease progression. In the NACT+RT arm, 10% of patients had disease progression whereas 25% of patients had complete pathological response. Transhiatal esophagectomy was performed in 60% of patients in the NACT arm, whereas in the NACT+RT arm, 80% of patients had three-stage esophagectomy. The average surgery duration was numerically greater for the NACT+RT arm; blood loss was also greater. Pulmonary complications and anastomotic leak rate were higher in NACT+RT arm whereas other complications such as hoarseness of voice, and wound dehiscence were higher in the NACT arm.

Conclusion: NACT+RT had better partial and complete response rates and low recurrence rates versus NACT. Post-operative complications were higher in the NACT+RT, especially pulmonary complications and anastomotic leak. Further, large-scale studies are warranted to confirm the efficacy of NACT versus NACT+RT in EC.

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Published

2024-02-01

How to Cite

Jha, R. K., Shalini Kumari, Sumedha Gargy, Rajen A Tankshali, & Kiran C Kothari. (2024). Surgical outcomes of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy in patients of locally advanced carcinoma of esophagus: A prospective cross-sectional comparative study. Asian Journal of Medical Sciences, 15(2), 202–207. https://doi.org/10.3126/ajms.v15i2.58705

Issue

Vol. 15 No. 2 (2024)

Section

Original Articles

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Copyright (c) 2023 Asian Journal of Medical Sciences

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