Purpose: Chemo-radiation followed by surgery (neoadjuvant chemo-RT) is the standard of practice for treating esophageal cancer. This study aims to investigate the practice pattern in the United States and also to compare outcome based on treatment pattern.
Methods: Between 2004 and 2018, a total of 9,799 esophageal adenocarcinoma patients were found in National Cancer Database (NCDB) who met the eligibility criteria and were included in this study. The patients were stratified into Stage-1 (n=992), Stage-2 (n=3,735) and Stage-3 (n=5,072) based on clinical staging criteria. A total of 8,849 patients were in neoadjuvant group and 950 were in adjuvant group. RT dose 30-55Gy was considered valid. IBM SPSS (version 26.0) was used for statistical analysis. Primary clinical goals were to evaluate practice pattern and to assess overall survival (OS). The OS was determined using Kaplan-Meier estimator. Any p-value less than 0.05 was considered statistically significant.
Results: Most of the patients were treated with neoadjuvantly prior to surgery (90.3%). The mean OS of Stage-1, -2, & -3 patients were: 65.5, 62.8 and 54.4 months, respectively, for neoadjuvant group, and those for adjuvant group were 65.7, 62.9 and 51.5 months, respectively. The median OS of Stage-1, -2, & -3 were: 59.8, 50.3 and 35.2 months for neoadjuvant group, whereas those for adjuvant group were 53.9, 55.1 and 33.8 months. None of the OS difference was found statistically significant (p>0.05).
Conclusion: Following the current treatment guidelines, majority of the patients underwent neoadjuvant treatment. Although neoadjuvant chemo-RT is the standard of care for esophageal cancer this study did not find any significant difference in OS when the patients received chemo-radiation adjuvantly after the surgery. Comparable effectiveness of neoadjuvant and adjuvant chemo-RT may provide the patients and the clinicians more flexibility and convenience of managing esophageal adenocarcinoma. Further study in this regard is warranted.