220. INDUCTION CHEMOTHERAPY FOLLOWED BY RESTAGING AND SURGERY FOR ADVANCED ESOPHAGEAL CANCER
Charlène Zijden, Pieter Sluis, Bianca Mostert, Joost Nuyttens, Manon Spaander, Eelke Toxopeus, Roelf Valkema, Sjoerd Lagarde, Bas Wijnhoven- Gastroenterology
- General Medicine
Abstract
Background
Patients with limited metastatic or advanced esophageal cancer have a poor prognosis and are often referred for palliative care. Induction chemotherapy may be considered as an alternative treatment. In patients with a good radiological response, treatment with curative intent may become feasible. The aim of this study was to assess overall survival (OS) in patients treated with induction chemotherapy.
Methods
Patients with esophageal or junctional cancer who underwent induction chemotherapy for advanced disease between 2003–2021 were identified from an institutional database. Response to induction chemotherapy was assessed by 18F-FDG-PET/CT or conventional CT-scan. Response to therapy and further treatment was discussed in the multidisciplinary tumor board. OS was calculated from date of diagnosis until date of death or last day of follow-up using the Kaplan Meier method. Univariable and multivariable analyses were performed to identify prognostic factors for survival.
Results
Some 238 patients were identified of whom 69% had esophageal adenocarcinoma. The majority of patients were treated with taxane/platinum based chemotherapy (79%). Response evaluation after induction chemotherapy was performed in 233 patients and 127 patients (53%) underwent esophagectomy. Median and 5-year OS after esophagectomy was 26.3 months (95% CI 18.8–33.8) and 29.6%, respectively. Patients who did not undergo surgery had a median OS of 12.6 months (95% CI 10.6–14.7) and 5-year OS rate of 6.4%. cT4b tumor (HR 2.01, 95% CI 1.02–3.92, p = 0.04) and poor tumor differentiation (G3) (HR 1.45, 95% CI 1.02–2.05, p = 0.04) were associated with worse survival.
Conclusion
In selected patients with advanced disease not amendable for standard treatment, induction chemotherapy followed by esophagectomy may achieve a 5-year overall survival of 30%. The presence of cT4b tumor or poor tumor differentiation (G3) were associated with worse survival.