KEY TAKEAWAYS
- The study aimed to investigate the optimal radiation dose in nCRT for locally advanced E/GEJ cancer.
- Researchers noticed a lower incidence of pCR with a preoperative radiation dose of 41.4 Gy in AC patients; however, the radiation dose showed no impact on postoperative outcomes.
Neoadjuvant chemoradiation (nCRT) followed by surgery stands as an established treatment for locally advanced esophageal or gastroesophageal junction (E/GEJ) cancer. However, the ongoing debate surrounds the determination of the optimal radiation dose. Styliani Mantziari and the team aimed to assess this critical aspect, delving into the impact of varying radiation doses on treatment outcomes.
Researchers performed an inclusive analysis encompassing all consecutive patients with E/GEJ tumors undergoing curative treatment from January 2009 to December 2016 in 2 referral centers. These patients were categorized into 3 groups based on preoperative radiotherapy doses (41.4 Gy, 45 Gy, and 50.4 Gy). Pathologic complete response (pCR) rates, postoperative morbidity, overall survival (OS), and disease-free survival (DFS) were meticulously compared across the three dose groups, with distinct assessments for adenocarcinoma (AC) and squamous cell carcinoma (SCC).
About 326 patients underwent analysis, with 48 (14.7%) in the 41.4 Gy group, 171 (52.5%) in the 45 Gy group, and 107 (32.8%) in the 50.4 Gy group. Postoperative complication rates were comparable (P = 0.399). pCR rates differed significantly: 15%, 30%, and 34% for the 41.4 Gy, 45 Gy, and 50.4 Gy groups, respectively (P = 0.047). In multivariate analysis, a 50.4 Gy dose was independently associated with pCR (odds ratio 2.78, 95% confidence interval 1.10-7.99). Among AC patients, pCR rates were 6.2%, 29.2%, and 22.7% for the 41.4 Gy, 45 Gy, and 50.4 Gy groups, respectively (P = 0.035). No differences in OS or DFS were observed.
The study concluded that a preoperative radiation dose of 41.4 Gy in AC patients resulted in a lower incidence of pCR. However, this radiation dose showed no significant impact on postoperative morbidity, long-term survival, or recurrence.
The study is sponsored by University of Lausanne
Source: https://pubmed.ncbi.nlm.nih.gov/38198002/
Mantziari S, Farinha HT, Messier M, et al. (2024). “Low-Dose Radiation Yields Lower Rates of Pathologic Response in Esophageal Cancer Patients.” Ann Surg Oncol. 2024 Apr;31(4):2499-2508. doi: 10.1245/s10434-023-14810-8. Epub 2024 Jan 10. PMID: 38198002; PMCID: PMC10908612.
