P120 multimodal therapy in esophageal cancer beyond clinical trial: single centre experience

Abstract Aim investigate factors influencing the choice of neoadjuvant treatment type in the real world, analyzing our single high-volume center experience. Background & Methods The neoadjuvant chemoradiotherapy is the standard of care for esophageal cancer [1-2]. This consensus stems from the results of CCT performed on highly selected patients. However, the best treatment for non-selected patients remains unclear. In our clinical practice the treatment considered the goal standard is a TCF with 50GyRT [3-4-5], which showed an R0 resection rate of 88% and 5 y OS of 43%, better than CROSS trial. Despite these results, since 2012 not all patients underwent the same ideal treatment. We analyzed a real life patients group, that from the oncological point of view, they would be treated with our protocol in an intention to treat setting. Results From 2012 to 2017, 244 patients were treated. Analyzing retrospectively our data, it emerges that we have chosen the therapeutic strategy based on patient's characteristics: those aged over 75 yrs or with severe comorbidities were addressed to a “weakened” treatment: 37 with chemotherapy, 24 with radiotherapy and 55 with concomitant chemoradiotherapy different from our protocol. 125 with our protocol. Further selection involved lymph node status and patients with lymph node involvement (>N2 were referred to chemotherapy. The results confirmed that the protocol achieves better results in pathological response (pT0N0 in protocol 40,8% vs 18.2% in standard chemoradiotherapy – p value <0.001) and overall survival, especially for squamous hystotype. Regarding adenocarcinoma, chemotherapy and our protocol obtain good results for OS, although they differ on pathological response (pCR: 40.8% vs 5.4%). Most of the patients referred to chemotherapy had nodes involvement at the diagnosis (88.9%) and pathological response on nodes was significantly worse than protocol (pN0: 26.7% in chemotherapy vs 77.5%), however survival was similar between the two treatments. Conclusion Chemoradiotherapy is currently the gold standard of treatment but it cannot be consider the only treatment, especially for real life patients, less ideal but still requiring treatment. Clinical trials are certainly useful in providing information on highly selected patients, but clinical practice must consider patients whose conditions require tailored treatment.