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Year : 2021  |  Volume : 4  |  Issue : 4  |  Page : 647-655

Neoadjuvant chemoradiotherapy followed by surgery for operable carcinoma esophagus: Ground reality in a tertiary care center of rural India - A retrospective audit

1 Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
2 Department of Surgical Oncology, Rajiv Gandhi Super Specialty Hospital, Delhi, India
3 Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
4 Department of Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
5 Department of Surgical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
6 Department of OncoPathology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
7 Department of Medical Physics, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India

Correspondence Address:
Tapas Kumar Dora
Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Civil Hospital Campus, Sangrur - 148 001, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_147_21

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Background: Carcinoma of the esophagus and gastroesophageal junction is an aggressive disease with limited survival. Standard management consists of multimodality therapy, incorporating chemotherapy, radiation, and surgery. Objectives: We aimed to understand the obstacles in treating patients with resectable esophageal cancer with neoadjuvant chemoradiotherapy followed by surgery. We also assessed the disease outcomes in the patients who completed surgery. Materials and Methods: We included patients with resectable esophageal carcinoma who received neoadjuvant chemoradiation between March 2017 and August 2019 at the Homi Bhabha Cancer Hospital in Sangrur, Punjab, a tertiary care center in rural India. As surgery for esophageal cancer was not performed at our center, patients had to be referred to a higher center for this. Patients were divided into two groups, based on the therapy they received following neoadjuvant chemoradiation: those who completed surgery (Group A) and those who did not (Group B). The pathologic response rates were noted. The disease-free survival (DFS) and overall survival (OS) were compared between the two groups. Results: A total of 55 patients (32 in Group A and 23 in Group B) were included the study. In Group A, complete pathologic responses were noted in 19 (59.4%), partial responses in 11 (34.4%) and poor responses in 2 (6.2%) patients. The major reasons for not undergoing surgery were patient refusal as they were feeling better after chemoradiation (8, 34.8%) and the presence of advanced inoperable (5, 21.7%) or metastatic disease (3, 13%) on imaging after chemoradiation. The median DFS in Group A and Group B was 8 months (range, 0–38 months) and 14 months (range, 0–29 months), respectively, and the 2-year DFS was 57.8% and 73.3%, respectively (P = 0.28). Median OS in Group A and Group B was 17 months (range, 3–43 months) and 17 months (range, 2–31 months), respectively, and the 2-year OS was 52.6% and 53.5%, respectively (P = 0.70). Conclusions: Implementing neoadjuvant chemoradiation followed by surgery for resectable esophageal cancer in a center where esophageal cancer surgery cannot be performed is challenging. Among patients who undergo surgery following neoadjuvant chemoradiation, complete pathologic responses occur in 59.4% patients, and clinical outcomes appear to be similar to those reported in the literature.

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