ESTRO 2024 - Abstract Book

S2141

Clinical - Upper GI

ESTRO 2024

Among 458 LS-SCEC patients, the median age was 63 (interquartile range [IQR], 57-68) years, 318 (69%) were males. Eighty-four (18%), 167 (36%), and 207 (45%) patients received chemotherapy (CT) alone, CT plus definitive radiotherapy (CT + RT), and CT plus radical surgery (CT + S), respectively. In CT + RT group, most (156, 93%) patients received at least 50 Gy with 1.8-2.0 Gy per fraction five days per week, and the average dose was 56.7 Gy (standard deviation [SD] 9.3Gy). In CT + S group, 126 (61%) received open esophagectomy; 81 (39%) received minimally invasive esophagectomy. With a median follow-up time of 58.7 (95% CI, 48.9-68.6) months, the median OS and 3 year OS rate for all patients 24.3 (95% CI, 21.6-27) months and 37.3% (95% CI, 32.8%-42.5%), respectively. Multivariate analysis indicated that treatment modes, Karnofsky performance status (KPS), TNM stage, and CT cycle were independent prognostic factors for overall survival (OS) (P < 0.05). Compared with CT alone, patients treated with CT + RT (HR, 0.57, 95% CI, 0.41-0.8, P = 0.001) or CT + S (HR, 0.59, 95% CI, 0.42-0.82, P = 0.002) had an improved OS, with no significant survival differences between CT + S and CT + RT groups after multivariate and PSM analyses (P > 0.05). Subgroup analysis indicated that compared with CT + RT, patients with tumor location at lower 1/3 (HR, 0.59, 95% CI, 0.37-0.93, P = 0.03) or tumor length > 5 cm (HR 0.52, 95% CI, 0.3-0.9, P = 0.02) could obtain significant OS benefit from CT + S. Patients with tumor location at middle 1/3 (HR 1.55, 95% CI, 1.03-2.36, P = 0.04) or tumor length ≤ 5 cm (HR 1.49, 95% CI, 1.02 -2.17, P = 0.04) favored CT + RT. The recurrence/progression events in locoregional, distant, and both sites of CT alone, CT + RT, and CT + S groups were 21 (38.9%), 19 (35.2%), 14 (25.9%); 30 (27.8%), 54 (50%), 24 (22.2%); and 34 (25.2%), 66 (48.9%), 35 (25.9%), respectively. Distant metastasis accounted for 73.7% of all treatment failures after multidisciplinary treatments. Brain metastasis accounted for 24.2% (n = 8), 17.9% (n = 14), 10.9% (n = 11) of all distant metastases in CT alone, CT + RT, and CT + S groups, respectively.