Long-term swallowing function following chemoradiotherapy for locoregionally advanced esophageal cancer: a retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Though the ESOPEC and MATTERHORN trials shifted the standard of care for resectable locally advanced esophageal adenocarcinoma to peri-operative FLOT and immunotherapy and esophagectomy from the CROSS regimen of neoadjuvant chemoradiation (CRT) followed by esophagectomy, patients who are ineligible for FLOT or surgery, decline standard of care, or have squamous cell carcinoma continue to standardly receive radiation. Strictures and/or dysphagia are common toxicities of esophageal CRT and can require procedural intervention. We examine rates of toxicity in a cohort receiving CRT +/− esophagectomy to identify incidence and drivers of swallowing toxicity.Methods: We conducted a retrospective single-institution cohort study of patients with T3–T4 or node positive, nonmetastatic adenocarcinoma or squamous cell carcinoma of the esophagus who received curative-intent CRT +/− esophagectomy between 2005 and 2013. Long-term swallowing function was assessed by the need for subsequent procedures, based on Current Procedural Terminology (CPT) codes for endoscopy with dilation and/or stent placement or feeding tube placement. Incidence rate ratios (IRRs) were determined using negative binomial regression modeling rates (number of subsequent swallowing procedures after treatment per person-time).Results: We assessed 103 consecutive patients; 77.0% of patients had a dysphagia score ≥1 at baseline, and 27.2% of patients had an esophageal stent in place during CRT. Most patients received 50.4 Gy in 28 fractions and 44.7% of patients received surgery after CRT. The median follow-up after completion of CRT was 70.1 months (95% confidence interval: 46.9–83.5 months) for living patients. At least one swallowing procedure was performed in 33.0% of patients (range, 1–20) after completion of curative treatment. The cumulative incidence of any local recurrence was 24%. On multivariable negative binomial regression patients with local recurrence [incidence rate ratio (IRR) 6.27, P=0.001] and squamous cell histology (IRR 5.12, P=0.04) were more likely to have higher rates of swallowing procedures after treatment, while patients who had an initial Karnofsky performance status (KPS) ≤80 (IRR 0.33, P=0.047) had lower rates of swallowing procedures.Conclusions: We demonstrate, in a real-world dataset, high rates of swallowing procedures in populations receiving curative intent CRT with or without esophagectomy. About one-third of patients received these procedures, a rate consistent with a dose-dependent relationship when contextualizing with other literature. Further work is needed to optimize the management of these patients, both to define optimal oncologic management and to optimize swallowing function in survivorship.
Source: Annals of Esophagus
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7166533481
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