title: Effect of neoadjuvant radiation dose on surgical and oncological outcome in locally advanced esophageal cancer.
abstract: BACKGROUND
  Neoadjuvant chemoradiation (CRT) confers a survival benefit in locally advanced esophageal cancer. The optimal dose of radiotherapy remains undefined.
  
  
  METHODS
  From a prospective database, we identified patients who received CRT followed by Ivor Lewis esophagectomy. Surgical complications, pathological response, and oncological outcome were compared between patients who received a radiotherapy (RT) dose of 36 Gy (group 1) versus a dose of > 40 Gy (group 2).
  
  
  RESULTS
  147 patients were evaluated : 109 received 36 Gy, while 38 received 41-50 Gy. Mean age was 61 ± 9 years (84% male). Median hospital stay was 16 days. Anastomotic leakage occurred in 4.0%. Pulmonary complications occurred in 41.8%, neither being influenced by RT dose. Complete resection (R0) was achieved in 95% (group 1) and 100% (group 2), P = 0.3. Pathological complete response (pCR) was observed in 19% (group 1) and 37% (group 2), P = 0.04. Local recurrence developed in 9% in group 1, and 3% in group 2 (P = 0.3), but regional recurrence developed significantly higher in the low dose group (28% vs 3%, P < 0.001). Metastatic recurrence occurred in 48% in group 1 and 13% in group 2 (P < 0.001).
  
  
  CONCLUSIONS
  In patients with locally advanced esophageal cancer a higher RT dose does not affect surgical outcome, enhances pCR rate, and reduces the locoregional and metastatic recurrence risk.
authors.affiliation: Departments of Gastrointestinal Surgery, Ghent University Hospital, 9000 Ghent, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Van Daele
authors.forename: W
authors.initials: W
authors.lastname: Ceelen
authors.forename: T
authors.initials: T
authors.lastname: Boterberg
authors.forename: O
authors.initials: O
authors.lastname: Varin
authors.forename: Y
authors.initials: Y
authors.lastname: Van Nieuwenhove
authors.forename: D
authors.initials: D
authors.lastname: Van de Putte
authors.forename: K
authors.initials: K
authors.lastname: Geboes
authors.forename: P
authors.initials: P
authors.lastname: Pattyn
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome