Definitive Chemoradiotherapy Versus Neoadjuvant Chemoradiotherapy Followed by Surgery in Locally Advanced Esophageal Cancer: A Retrospective Evaluation of Clinical Data of Two Centers

INTRODUCTION: The aim of this study is to investigate the results of neoadjuvant chemoradiotherapy /radiotherapy (neo-CRT/RT)+surgery and definitive chemoradiotherapy (def-CRT) approaches in locally advanced esophageal cancer
METHODS: Between January 2012 and December 2021, in two centers, patients who received def-CRT or neo-CRT/RT with the diagnosis of locally advanced esophageal cancer, were retrospectively analyzed. Cases were evaluated for treatment response, overall survival (OS), disease-free survival (DFS), and local recurrence (LR).
RESULTS: In total, fifty cases were included. The median follow-up was 10 months (range 2-26). In the def-CRT group; OS at one year, and two years were 67 % and 32 %, respectively; DFS at one year, and two years were 62 % and 32 % respectively. In the neo-CRT group; OS at one year was 81 % and DFS at one year was 73 %. In the follow-up time, LR was 12.1% in def-CRT and 11.8% in the neo-CRT group. For two treatment arms, there were no significant differences in OS (p=0.404), DFS (p=0.593) and LR (p=0.670). The neo-CRT group was evaluated according to the time of surgery, more mortality was found in patients who underwent surgery after 8 weeks, although statistical significance was not reached.
DISCUSSION AND CONCLUSION: Considering the morbidity and mortality of surgery, def-CRT may be an alternative to neoadjuvant-surgical treatment in selected cases whose treatment response is considered a complete response. In these patients, waiting until recurrence and then salvage surgery can be considered.

Lokal Ýleri Özofagus Kanserinde Definitif Kemoradyoterapi ile Neoadjuvant Kemoradyoterapiyi Takiben Cerrahinin Karþýlaþtýrýlmasý: Ýki Merkezin Klinik Verilerinin Retrospektif Deðerlendirilmesi

GÝRÝÞ ve AMAÇ: Lokal ileri özofagus kanserinde neoadjuvan kemoradyoterapi/radyoterapi (neo-KRT/RT)+cerrahi ve definitif kemoradyoterapi (def-KRT) yaklaþýmlarýnýn sonuçlarýný araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Ocak 2012 ile Aralýk 2021 tarihleri arasýnda iki merkezde lokal ileri özofagus kanseri tanýsý ile def-KRT veya neo-KRT/RT alan hastalar retrospektif olarak incelendi. Olgular tedavi yanýtý, genel saðkalým, hastalýksýz saðkalým ve lokal nüks açýsýndan deðerlendirildi.
BULGULAR: Toplamda elli vaka çalýþmaya dahil edildi. Medyan takip süresi 10 (2-26) ay’dý. Def-KRT grubunda; Bir yýllýk ve iki yýllýk genel saðkalým sýrasýyla %67 ve %32; bir yýllýk ve iki yýllýk hastalýksýz saðkalým sýrasýyla %62 ve %32 idi. Neo-KRT grubunda; bir yýllýk genel saðkalým %81 ve bir yýllýk hastalýksýz %73 idi. Takip süresince lokal nüks oraný, def-KRT grubunda %12.1 ve neo-KRT grubunda %11.8 idi. Ýki tedavi kolu arasýnda, genel saðkalým (p=0,404), hastalýksýz saðkalým (p=0,593) ve lokal nüks (p=0,670) açýsýndan anlamlý fark yoktu. Neo-KRT grubu ameliyat zamanýna göre deðerlendirildiðinde, 8 haftadan sonra ameliyat edilen hastalarda istatistiksel anlamlýlýða ulaþýlamasa da daha fazla mortalite saptandý.
TARTIÞMA ve SONUÇ: Cerrahinin morbidite ve mortalitesi göz önüne alýndýðýnda, tedaviye yanýtý tam yanýt olarak kabul edilen seçilmiþ olgularda def-KRT, neoadjuvan+cerrahi tedaviye bir alternatif olabilir. Bu hastalarda nükse kadar bekleyip ardýndan salvaj cerrahi düþünülebilir.