Abstract
Background: Neoadjuvant chemoradiotherapy (nCRT) is the standard of care for resectable esophageal cancer. However, existing clinical data are largely outdated. Alongside advancements in radiotherapy techniques, this study aims to evaluate the initial efficacy and safety profile of nCRT utilizing Volumetric Modulated Arc Therapy (VMAT) in patients with middle-to-lower third, stage II-IVA ESCC.
Methods: This longitudinal descriptive study included 56 patients treated with preoperative chemoradiotherapy using the Paclitaxel-Carboplatin regimen and the VMAT technique
Results: Mean age of the cohort was 56.1 years. Stage III disease accounted for 53.6%, and the baseline lymph node metastasis (N+) rate was 73.2% The overall response rate (ORR) following nCRT was 98.2%, with 1 patient (1.78%) experiencing disease progression. The pathological complete response (pCR) rate was 34.5%. With a median follow-up time of 21.4 months, the 1-year disease-free survival (DFS) rate was 83.9%. Univariate and multivariate analyses identified post-treatment nodal status (ypN) as an independent prognostic factor for DFS.
Conclusion: Neoadjuvant chemoradiotherapy using VMAT for esophageal squamous cell carcinoma offers a high response rate, a notable pCR rate, safety, and ypN as an important prognostic factor.
Keywords: ESCC, neoadjuvant chemoradiation, VMAT, CROSS
References
Bray, F., et al., Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 2024. 74(3): p. 229–263.
Shapiro, J., et al., Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. The Lancet Oncology, 2015. 16(9): p. 1090–1098.
Tepper, J., et al., Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol, 2008. 26(7): p. 1086–92.
Tozzi, A., et al., Neoadjuvant Chemoradiotherapy with Volumetric-modulated Arc Therapy for Medium-distal Oesophageal and Gastro-oesophageal Junction Carcinoma. Anticancer Res, 2015. 35(7): p. 4109–16.
Huang, T.-T., et al., The Impact of Weight Loss during Chemoradiotherapy for Unresectable Esophageal Cancer: Real-World Results. Life, 2022. 12(5): p. 706.
Wiwitkeyoonwong, J., et al., Impact of Weight Loss on Patients with Locally Advanced Esophageal and Esophagogastric Junction Cancers Treated with Chemoradiotherapy. Asian Pacific Journal of Cancer Prevention, 2021. 22: p. 3847–3855.
Hagen, P.v., et al., Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer. New England Journal of Medicine, 2012. 366(22): p. 2074–2084.
Gao, X., et al., Neoadjuvant Carboplatin/Paclitaxel versus 5-Fluorouracil/Cisplatin in Combination with Radiotherapy for Locally Advanced Esophageal Squamous Cell Carcinoma: A Multicenter Comparative Study. Cancers, 2022. 14(11): p. 2610.
Gao, X., et al., Pathological response to neoadjuvant chemoradiotherapy for oesophageal squamous cell carcinoma in Eastern versus Western countries: meta-analysis. The British Journal of Surgery, 2024. 111(5): p. znae083.
Huang, R.-W., et al., Predictors of pathological complete response to neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma. World Journal of Surgical Oncology, 2014. 12(1): p. 170.
Tang, H., et al., Nodal Downstaging of Esophageal Squamous Cell Carcinoma after Neoadjuvant Chemoradiotherapy: Survival Analysis if ypN0 Is Achieved. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, 2020. 24(7): p. 1469–1476.
Wang, Q., et al., Residual lymph node status is an independent prognostic factor in esophageal squamous cell Carcinoma with pathologic T0 after preoperative radiotherapy. Radiation Oncology (London, England), 2015. 10: p. 142.
Kelly, R.J., et al., Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer. The New England Journal of Medicine, 2021. 384(13): p. 1191–1203.
Vivekanandan, N., et al., Volumetric modulated arc radiotherapy for esophageal cancer. Med Dosim, 2012. 37(1): p. 108–13.
Abana, C.O., et al., Comparative Outcomes and Toxicity in Patients With Esophageal Cancer After Trimodality Therapy With Step-and-Shoot Intensity-Modulated Radiation Therapy Versus Volumetric Modulated Arc Therapy: The MD Anderson Experience. Clinical Oncology, 2025. 38.
| Published | 18-08-2026 | |
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| Issue | Vol. 18 No. 5 (2026) | |
| Section | Original article | |
| DOI | 10.38103/jcmhch.18.5.18 | |
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