Response Evaluation with Definitive Chemoradiotherapy in Carcinoma of the Esophagus

Abstract

Objective: i) To evaluate the treatment outcomes of patients with carcinoma of the esophagus receiving definitive chemoradiation using IMRT with concurrent chemotherapy and ii) To assess patient demographics and disease characteristics in relation to treatment response and patterns at a single tertiary care center.

Methodology: This prospective cohort study was conducted in the Department of Radiation Oncology at Shifa International Hospital from June 2024 to November 2024. A total of 133 patients with biopsy-proven esophageal carcinoma, aged 16 to 65 years, were enrolled using non-probability consecutive sampling. All patients received definitive chemoradiation, consisting of either 5040 cGy in 28 fractions or 5400 cGy in 30 fractions delivered via intensity-modulated radiation therapy (IMRT), along with concurrent chemotherapy. Chemotherapy regimens included either weekly carboplatin (AUC 2) and paclitaxel (50 mg/m²) for five weeks, or cisplatin (75 mg/m² on day 1) combined with continuous infusion of fluorouracil (1000 mg/m²/day for 96 hours) during weeks 1 and 5 of external beam radiotherapy.

Results: Out of 133 patients, 78 (63%) were males and 55 (37%) were females. Most patients (n = 79, 59%) had stage II disease, while 46 (34%) had stage III disease. An objective complete response was achieved in 66 patients (61%), while partial response was observed in 67 patients (38%). The majority of patients achieving complete response had squamous cell carcinoma histology (66%). No patients died or experienced disease progression during treatment. Grade 3 mucositis occurred in 7 patients (5%), grade 3 dysphagia in 9 patients (7.5%), and grade 3 myelosuppression in 3 patients (2.2%).

Conclusions: Patients treated with definitive concurrent chemoradiotherapy (CCRT) for non-metastatic carcinoma of the esophagus demonstrated promising outcomes, with a complete remission rate of 66%. Complete response was more frequently observed in patients with squamous histology. A significant correlation was noted between radiological stage and pathological complete response, with stage II patients showing the highest frequency of complete responses.