2007 - Radical Surgery vs. Definitive Radiotherapy after Neoadjuvant Immunochemotherapy in Treatment of Locally Advanced Esophageal Squamous Cell Carcinoma
Presenter(s)
Q. An1, H. Wang2, Y. Jia1, M. Liu1, Y. Wang1, H. Ji1, Y. Su1, H. Si1,3, Z. Zhang1, J. Yan1, J. Bai1, P. Zhang1, and Z. Zhou1; 1Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China, 2Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, shijiazhuang, Hebei, China, 3Department of Oncology, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
Purpose/Objective(s): To compare the survival outcomes and recurrence patterns of radical surgery and definitive radiotherapy (RT) following neoadjuvant immunochemotherapy (NICT) in patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC).
Materials/Methods: Patients with LA-ESCC who underwent NICT between January 2019 and June 2023 were retrospectively enrolled and categorized into surgery or RT groups. Propensity score matching (PSM) and the Kaplan-Meier method were used to estimate progression-free survival (PFS) and overall survival (OS). Compared the differences in recurrence patterns between the two groups.
Results: A total of 278 patients were included, comprising 218 (78.4%) and 60 (21.6 %) patients in the surgery and RT groups, respectively. After PSM, the surgery group (n=117) maintained a significant OS benefit over the RT group (n=60) (3-year OS rates: 72.1% vs. 59.5%; P=0.028), whereas the PFS rates were comparable between the two groups (3-year PFS rates: 59.4% vs. 46.9%; P=0.12). For patients with upper esophageal cancer, RT showed a trend toward improved survival (3-year PFS rates: 76.9% vs. 55.5%, P=0.34; 3-year OS rates: 74.0% vs. 61.8%, P=0.50). Furthermore, among the responders after NICT (near-cCR/cPR), PFS and OS were similar between the surgery and RT groups (3-year PFS rates: 68.9% vs. 66.9%, P=0.64; 3-year OS rates: 80.2% vs. 70.7%, P=0.20). Regional lymph node recurrence predominated in the surgery group (50.0%), whereas locoregional esophageal recurrence was most frequent in the RT group (37.0%). The treatment-related mortality rates were 0.8% (1/117) in the surgery group and 1.7% (1/60) in the RT group, indicating the overall safety of the treatments.
Conclusion: Radical surgery remains the standard treatment for LA-ESCC patients following NICT, but definitive RT offers a safe organ-preserving alternative for patients with upper esophageal cancer or those with a robust response to NICT.