ESTRO 2024 - Abstract Book

S2260

Clinical - Upper GI

ESTRO 2024

Survival in Squamous Cell Cervical Esophageal Carcinoma: retrospective comparison of Surgery and RT

Edoardo Gozzelino 1 , Giuseppe Carlo Iorio 1 , Ali Hoteit 2 , Fabio Menegatti 1 , Diego Bongiovanni 1 , Sara Bartoncini 1 , Valeria Chiofalo 1 , Cristiano Grossi 1 , Erica Maria Cuffini 1 , Giuliana Petruzzellis 1 , Bruna Lo Zito 1 , Ramona Parise 1 , Chiara Casale 1 , Francesca Catena 1 , Eulalie Joelle Tondji Ngassam 1 , Alessio Gastino 1 , Marzia Cerrato 1 , Ilaria Bonavero 1 , Renato Romagnoli 2 , Paolo Strignano 2 , Umberto Ricardi 1 1 University of Turin, Department of Oncology, Turin, Italy. 2 Turin University Hospital, Department of General Surgery, Turin, Italy

Purpose/Objective:

Survival outcomes comparison between surgery and chemo-radiotherapy (CTRT) when treating non-metastatic cervical squamocellular esophageal cancer (CESCC).

Material/Methods:

We performed a single-center retrospective survival analysis in a population of non-metastatic CESCC treated between 2013 and 2023: upfront surgery (Group 1), trimodality-therapy (TMT, Group 2), and definitive CTRT (Group 3). The primary endpoint was to compare overall survival (OS) among the treatment groups. Secondary study endpoints included: toxicity analysis and response rates to neoadjuvant treatment in Group 2.

Results:

48 non-metastatic CESCC were evaluated: 15 patients in Group 1, 16 in Group 2, and 17 in Group 3. For Group 1, 66.7% of the patients were male, 53.3% regularly consumed alcohol, and 53.3% were smokers. Of those 15 patients, 40% presented a G2 tumor and 46.7% a G3 tumor. In this group, 26.7% of the tumors were clinically staged as a T3 and 20% as a T4. For the nodal positivity, 20% of the patients presented a cN1 disease and 13.3% a cN2. The pathological staging showed a pT3 tumor in 40% of the patients, a pT4 in 20%, a pN1 in 26.7%, and a pN2 in 26.7%. In Group 2, 75% of the patients were male, 53.3% had a history of alcohol consumption, and 81.25% were smokers. Of those 16 patients, 18.8% presented a G2 tumor and 43.8% a G3 tumor. For the clinical staging, 68.8% were cT3, 6.3% cT4, 43.8% cN1, and 25% cN2. The pathological staging showed a pT3 tumor in 6.3% of the patients, a pT4 in 25%, a pN1 in 31.8%, and a pN2 in 18.8%. A pathological downstaging was observed in 43.8% of cases. No cases of complete pathological response were reported. The median neoadjuvant conventionally fractionated IMRT dose was 41.4 Gy (maximal neoadjuvant RT dose prescribed 50.4 Gy). In Group 3, 58.8% of the patients were male, with a history of alcohol consumption in 76.5% of the cases and tobacco smoking in 52.9%. 76.5% of the tumors were staged as cT3, 17.6% as cT4, 41.2% as cN1, and 41.2% as cN2. The average radiation dose delivered with conventionally fractionated IMRT was 56 Gy (maximal dose prescribed 62 Gy). Figure 1 depicts survival among the three Groups. Survival rates at 1-, 3-, and 5-years were as follows: 78%, 70%, and 35% for Group 1; 75%, 45%, and 30% for Group 2; 60%, 45%, and 35% for Group 3, respectively (p=0.943). Analyzing the differences in terms of complications between patients who had upfront surgery and those who underwent TMT, no statistically significant differences emerged in terms of hemorrhagic, infectious, respiratory, or cardiovascular complications (p= 0.472). In Group 3, only two patients showed a grade > 2 CTCAE toxicity (cutaneous and dysphagia). No salvage surgeries were performed in Group 3.