Neoadjuvant Chemoradiotherapy in Resectable Oesophageal Cancer Patients: UK Practice


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Caitlin Bowden1,Sarah Gwynne2,Paul Shaw3
1Velindre Cancer centre,2South West Wales Cancer Centre,3Velindre Cancer Centre

Abstract

Background

In the UK it is unclear as to the optimal neoadjuvant regimen for resectable oesophageal cancer; chemotherapy or chemoradiotherapy (CRT). CRT has not been widely adopted, whereas neoadjuvant (NA) chemotherapy is favoured, after publication of the 0E02 clinical trial (two cycles of induction chemotherapy). 

The CROSS trial demonstrated an improved overall survival and progression free survival in patients who had NA chemoradiotherapy (NACRT) and surgery, versus surgery alone, with no increase in post-operative complications. The Neo-AEGIS trial is currently recruiting and is comparing peri-operative chemotherapy with NA CRT, prior to surgery. Pending results of this trial and/or national guidance on optimal neoadjuvant therapy, there will remain a difference in practice between centres.

 

Method

A questionnaire was created using Survey Monkey. The target recipients were UK upper GI oncologists. The questions focused on the differing neo-adjuvant treatments used and the reasons for the different practices.

 

Results

Twenty-three surveys were completed. 78.3% centres use some NACRT. 26% of consultants treat either squamous or adenocarcinomas with NACRT whereas 47.8% treat both. The most common reason for not using NACRT was that it is not standard of care in the UK. It was felt more data on safety/ efficacy and superiority over NA chemotherapy is needed. 60.9% of consultants use carboplatin/ paclitaxel as the chemotherapy regime in NACRT. 60% use NA chemotherapy as well as NACRT. 45Gy in 25 fractions, 41.4Gy in 23 fractions and 50Gy in 25 fractions were used by 50%, 40% and 5% of centres respectively.

Conclusion

There is currently no consensus on the role of NACRT for resectable oesophageal cancer across the UK. Variation is in use of NA chemotherapy, concurrent chemotherapy and dose/fractionation. Trials, such as Neo-AEGIS and national guidance will help to reach a consensus.