ESTRO 2019 – Dose intensity affects the pathological response in patients with oesophageal cancer treated with neoadjuvant CRT


  • Elena Riboldi — Agenzia Zoe
  • Univadis
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Takeaway

  • A higher radiation dose increases the probability of achieving a pathological major response (pMR) in patients with oesophageal cancer treated with chemoradiotherapy followed by surgery.

Why this matters

  • There is no consensus about the optimal regimen of radiotherapy for the treatment of patients with oesophageal cancer.
  • This large multi-institutional experience suggests that the selection of a sufficiently high radiation dose is critical in radiotherapy planning for these patients.

Study design

  • The study included 1102 consecutive patients who underwent neoadjuvant chemoradiotherapy (nCRT) for locally advanced/resectable squamous cell carcinoma (SCC) or adenocarcinoma (AC) of the oesophagus between 2000 and 2017 at four high-volume university medical centres.
  • Patients were stratified according to a prescribed radiation dose of 36 Gy, 40 Gy, 41.4 Gy, 45 Gy, or 50.4 Gy (in fractions of 1.8 Gy or 2 Gy).
  • A multivariable logistic regression analysis was used to explore the relation between radiation dose and pMR, defined as Mandard 1 (no residual tumour cells) or Mandard 2 (
  • Clinical variables considered in the analysis included: clinical tumour stage, histology, chemotherapy regimen, use of induction chemotherapy, and the time interval from nCRT to surgery.

Key results

  • The majority of patients had AC (74.3%); patients received either 36 Gy (n=162; 14.7%), 40 Gy (n=79; 7.2%), 41.4 Gy (n=211; 19.1%), 45 Gy (n=271; 24.6%) or 50.4 Gy (n=379; 34.4%).
  • A pMR was obtained in 606 patients (55.0%); in the subgroup analysis according to the histological type, a pMR was achieved by 419/819 (51.2%) patients with AC and 187/283 (66.1%) patients with SCC.
  • In the multivariable analysis, total neoadjuvant radiation dose (per Gy) increased the probability of reaching a pMR (OR 1.04; 95%CI 1.02-1.04; P
  • This result was confirmed in the subgroup analysis according to the histological type:
  • AC: OR 1.02 (95%CI 1.01-1.04; P
  • SSC: OR 1.05 (95%CI 1.02-1.08; P