CLINICAL OUTCOMES OF NEOADJUVANT CONCURRENT CHEMORADIOTHERAPY USING VOLUMETRIC MODULATED ARC THERAPY IN PATIENTS WITH STAGE II-IVA MIDDLE AND LOWER THORACIC ESOPHAGEAL CANCER
Main Article Content
Abstract
Objectives: Evaluation the initial efficacy and safety profile of neoadjuvant chemoradiotherapy utilizing volumetric modulated arc therapy in patients with middle-to-lower third, stage II-IVA esophageal cancer.
Methods: This longitudinal descriptive study included 71 patients treated with preoperative chemoradiotherapy using the Paclitaxel-Carboplatin regimen and the volumetric modulated arc therapy technique.
Results: The mean age of the patients was 56.1 years; 100% patients were male; stage III disease accounted for 53.5%; and the baseline lymph node metastasis (N+) rate was 70.4%. The overall response rate following neoadjuvant chemoradiotherapy was 90.1%; the resection rate after chemoradiotherapy was 91.5%; and the pathological complete response rate was 32.4%. Tumor stage and clinical response to chemoradiotherapy were significantly associated with the likelihood of achieving pathological complete response.
Conclusion: Preoperative chemoradiotherapy using volumetric modulated arc therapy technique for middle-to-lower third squamous cell carcinoma of the esophagus is an effective and well-tolerated regimen with a high response rate.
Article Details
Keywords
Esophageal cancer, pre-operative, VMAT, CROSS.
References
[2] Shapiro J, van Lanschot J.J.B et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16 (9): 1090-1098. doi: 10.1016/S1470-2045(15)00040-6
[3] Tepper J, Krasna M.J, Niedzwiecki D et al. Phase III trial of trimodality therapy with Cisplatin, Fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol, 2008, 26 (7): 1086-1092. doi: 10.1200/JCO.2007.12.9593
[4] Tozzi A, Iftode C, Cozzi L et al. Neoadjuvant chemoradiotherapy with volumetric-modulated arc therapy for medium-distal oesophageal and gastro-oesophageal junction carcinoma. Anticancer Res, 2015, 35 (7): 4109-4116.
[5] Huang T.T, Chou S.Y, Lin Y.H et al. The impact of weight loss during chemoradiotherapy for unresectable esophageal cancer: real-world results. Life (Basel) , 2022, 12 (5): 706. doi: 10.3390/life12050706
[6] Gao X, Overtoom H.C.G, Eyck B.M et al. Pathological response to neoadjuvant chemoradiotherapy for oesophageal squamous cell carcinoma in Eastern versus Western countries: meta-analysis. Br J Surg, 2024, 111 (5): znae083. doi: 10.1093/bjs/znae083
[7] Abana C.O, Carriere P.P, Damen P.J et al. Comparative outcomes and toxicity in patients with esophageal cancer after trimodality therapy with step-and-shoot intensity-modulated radiation therapy versus volumetric modulated arc therapy: the md anderson experience. Clinical Oncology, 2025, 38. doi: 10.1016/j.clon.2024.103668
[8] Juloori A, Tucker S.L, Komaki R et al. Influence of preoperative radiation field on postoperative leak rates in esophageal cancer patients after trimodality therapy. Journal of Thoracic Oncology, 2014, 9 (4): 534-540. doi: 10.1097/JTO.0000000000000100
[9] Jin Z, Zhang J, Chen D et al. Neoadjuvant chemoradiotherapy, chemotherapy, and radiotherapy do not significantly increase the incidence of anastomotic leakage after esophageal cancer surgery: a meta-analysis. Dis Esophagus, 2022, 35 (9): doab089. doi: 10.1093/dote/doab089
[10] Zhou D, Chen D, Song P et al. Does neoadjuvant therapy contribute to increased risk in anastomotic leakage of esophageal cancer? A network meta-analysis. Journal of Evidence-Based Medicine, 2024, 17 (3): 559-574. doi: 10.1111/jebm.12634