ESTRO 2025 - Abstract Book

S1808

Clinical – Upper GI

ESTRO 2025

studies evaluated treatment outcomes for patients with cN3M0 disease specifically. The aim of this real-world population-based study was to assess survival outcomes after different treatment strategies in patients with cN3M0 esophageal cancer. Material/Methods: All patients diagnosed with cN3M0 esophageal cancer in the Netherlands between 2015 and 2022 were included from the Netherlands Cancer Registry. We recognized 4 different intention-to-treat strategies: neoadjuvant chemoradiotherapy generally followed by resection (nCRT), definitive chemoradiotherapy (dCRT), perioperative chemotherapy (pCT) or palliative therapy (including both palliative chemotherapy and palliative radiotherapy, excluding best supportive care (BSC)). Overall survival (OS) was compared among these 4 groups and separately for a propensity-score matched (PSM) cohort comparing nCRT and dCRT. Matching variables included gender, age, performance status, body mass index (BMI), Charlson comorbidity index, histology, cT-stage, tumor location and year of diagnosis. Recurrence patterns were available and studied in the years 2015-2018. Results: Between 2015-2022, 19,867 patients were diagnosed with esophageal cancer in the Netherlands, of whom 316 were staged cN3M0, 51 were excluded for analysis because of unknown treatment or BSC. Of these, 134 received nCRT, 59 dCRT, 11 pCT and 61 palliative therapy. Histology was adenocarcinoma in 182 patients (69%) and squamous cell carcinoma in 83 patients (31%). The amount of patients proceeding to esophagectomy was 92 (69%) in the nCRT and 3 (5%) in the dCRT group. After esophagectomy, 39 patients (41.1%) were staged ypN0, 17 patients (17.9%) were staged ypN1, 22 patients (23.2%) ypN2 and 17 patients (17.9%) ypN3. Median follow up of surviving patients was 40.2 months, median OS was 18.8 months for nCRT versus 15.2 months for dCRT (HR 0.76, 95% CI: 0.54-1.08), 18.9 months for pCT and 7.1 months for palliative therapy (Figure 1A). After PSM (n=38 in both groups), median OS was 17.6 months versus 16.1 months with nCRT versus dCRT, respectively (HR 0.78, 95% CI: 0.46-1.31; Figure 1B). Recurrences consisted of distant progression (with or without locoregional progression) in 85.5% of recurrences.

Conclusion: This real-world hypothesis-generating data suggests that for cN3M0 esophageal cancer, adding surgery to chemoradiotherapy may be of limited value. Instead, as recurrences mainly include distant metastases, emphasis should be placed on improving systemic control.

Keywords: esophagus, cN3M0, treatment