Low-Dose Radiation Yields Lower Rates of Pathologic Response in Esophageal Cancer Patients.

Autor: Mantziari S; Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland. styliani.mantziari@chuv.ch.; Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland. styliani.mantziari@chuv.ch., Farinha HT; Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.; Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland., Messier M; Department of Digestive and Oncological Surgery, CHU Lille, Lille, France., Winiker M; Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland., Allemann P; Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.; Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland., Ozsahin EM; Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland.; Department of Radiation Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland., Demartines N; Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.; Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland., Piessen G; Department of Digestive and Oncological Surgery, CHU Lille, Lille, France.; CNRS, Inserm, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, CHU Lille, Univ. Lille, Lille, France., Schäfer M; Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.; Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Apr; Vol. 31 (4), pp. 2499-2508. Date of Electronic Publication: 2024 Jan 10.
DOI: 10.1245/s10434-023-14810-8
Abstrakt: Background: Although neoadjuvant chemoradiation (nCRT) followed by surgery is standard treatment for locally advanced esophageal or gastroesophageal junction (E/GEJ) cancer, the optimal radiation dose is still under debate.
Objective: The aim of this study was to assess the impact of different preoperative radiation doses (41.4 Gy, 45 Gy or 50.4 Gy) on pathologic response and survival in E/GEJ cancer patients.
Methods: All consecutive patients with E/GEJ tumors, treated with curative intent between January 2009 and December 2016 in two referral centers were divided into three groups (41.4 Gy, 45 Gy and 50.4 Gy) according to the dose of preoperative radiotherapy. Pathologic complete response (pCR) rates, postoperative morbidity, overall survival (OS) and disease-free survival (DFS) were compared among the three groups, with separate analyses for adenocarcinoma (AC) and squamous cell carcinoma (SCC).
Results: From the 326 patients analyzed, 48 were included in the 41.4 Gy group (14.7%), 171 in the 45 Gy group (52.5%) and 107 in the 50.4 Gy group (32.8%). Postoperative complication rates were comparable (p = 0.399). A pCR was observed in 15%, 30%, and 34% of patients in the 41.4 Gy, 45 Gy and 50.4 Gy groups, respectively (p = 0.047). A 50.4 Gy dose was independently associated with pCR (odds ratio 2.78, 95% confidence interval 1.10-7.99) in multivariate analysis. Within AC patients, pCR was observed in 6.2% of patients in the 41.4 Gy group, 29.2% of patients in the 45 Gy group, and 22.7% of patients in the 50.4 Gy group (p = 0.035). No OS or DFS differences were observed.
Conclusions: A pCR was less common after a preoperative radiation dose of 41.4 Gy in AC patients. Radiation dose had no impact on postoperative morbidity, long-term survival, and recurrence.
(© 2024. The Author(s).)
Databáze: MEDLINE
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