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Outcomes in patients with locally advanced esophageal cancer after neoadjuvant concurrent chemoradiation: A retrospective study from low- to middle-income countries
Background
Esophageal cancer is a highly aggressive tumor often associated with poor prognosis. Globally the incidence and prevalence rates of esophageal cancer vary a lot. Genetic and phenotypic variations in different populations have variable survival outcomes. Concurrent chemoradiation as per Cross Trial is standard of care and now being widely used in Pakistan, however there is scarcity of data in our population. This study aims at identifying the disease-free survival of patients treated with Cross trial in our tertiary care institute.
Methods
This was a descriptive cross-sectional single-centre study conducted at Aga Khan University Hospital, Karachi. A total of 88 patients were enrolled from 1st January 2015 till 31st December 2019. The medical records of all the patients coded for esophageal cancer as per International Classification of Diseases-9 coding system were reviewed. All adult male and female patients of age >18 years, ECOG 0-2 and treated with neoadjuvant concurrent chemoradiation using Carboplatin and Paclitaxel regimen were included. However, patients with upper one-third of esophageal cancers, metastatic disease, missing records, data or file, received other chemotherapy regimen or partially treated were excluded from the study. Disease-free survival was assessed by performing computed tomography imaging at six months of completing neoadjuvant concurrent chemoradiation. Effect modifiers were controlled through stratification. Post-stratification chi-square was applied and p-value of < 0.05 was considered significant.
Results
A total of 88 patients were included with median age of 55 (43-67) years.Majority of the patients were male (54.5%). Of total population seventy-eight (88.6%) showed disease-free survival.Ten patients (11.4%) died either due to post-surgical complications (n=3) or disease recurrence (n=7).In this study mean time of disease recurrence was 5.8 months.There was survival advantage for patients who achieved complete or partial response as a result of the preoperative treatment with significant p-value < 0.05.
Conclusions
The study showed that all patients completed their treatment and tolerated the regimen very well. This study identified that there is significant role of neoadjuvant concurrent chemoradiation in down staging the initial tumor bulk. Majority of the patients remained alive and had no recurrence at six months of treatment completion.This study provides local data specific to our population and will be reliable reference for those who want to further explore in this area.
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
