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Hegemann, Nina-Sophie; Koepple, Rebecca; Walter, Franziska; Böckle, David; Fendler, Wolfgang P.; Angele, Martin Kurt; Böck, Stefan; Belka, Claus; Röder, Falk (2018): Neoadjuvant chemoradiation for esophageal cancer Surgery improves locoregional control while response based on FDG-PET/CT predicts survival. In: Strahlentherapie und Onkologie, Vol. 194, No. 5: pp. 435-443
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To retrospectively analyze the outcome of patients with esophageal cancer treated with neoadjuvant chemoradiation. A total of 41 patients received neoadjuvant intent chemoradiation for esophageal cancer. Most patients had a locally advanced disease (T3/4: 82%, N+: 83%, M0: 100%) and squamous cell carcinoma (83%). All patients received concurrent chemotherapy with cisplatin/5-fluorouracil or mitomycin/5-fluorouracil. Median radiation dose was 50.4aEuroGy in the 25 patients who proceeded to surgery and 57.4aEuroGy in 16 patients who did not undergo surgery. FDG-PET/CT was used for treatment planning in 24 patients. A second FDG-PET/CT was available for response evaluation in 18 patients. Median follow-up was 16 months in all patients and 30 months in survivors. Radiotherapy was completed without interruptions > 3 days in 90% of patients, and chemotherapy was carried out to > 80% in 85% of patients. The 2aEuroyear locoregional control rate was 60%, distant control rate 54% and overall survival rate 50%. Hematological toxicity grade 3/4 was observed in 34%/10% of patients and non-hematological toxicity grade 3/4 in 46%/2% of patients. Perioperative 30-day mortality was 4%. Subgroup analyses revealed that surgery significantly improved locoregional control (74% vs. 39%, paEuro= 0.034), but not the 2aEuroyear survival rate (54% vs. 43%, paEuro= 0.246). In contrast, response based on FDG-PET/CT prior and after chemoradiation significantly predicted improved overall survival (2-year overall survival 61% vs. 40%, paEuro= 0.048). Outcomes of our cohort were comparable to other series using similar treatments. Surgery significantly improved locoregional control but not survival. Response based on FDG-PET/CT predicted survival and might be used for treatment stratification.