Real-world outcomes after concurrent chemo-radiotherapy in patients with locally advanced esophageal and gastroesophageal junction cancer

Authors

  • Hanna Rahbek Mortensen Danish Center of Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Science, Aarhus University, Aarhus, Denmark https://orcid.org/0000-0001-5759-5349
  • Lone Hoffmann Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Science, Aarhus University, Aarhus, Denmark https://orcid.org/0000-0002-3575-0421
  • Marianne Nordsmark Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Science, Aarhus University, Aarhus, Denmark https://orcid.org/0000-0002-8167-1273
  • Lise Bech Jellesmark Thorsen Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Science, Aarhus University, Aarhus, Denmark https://orcid.org/0000-0002-4533-1642
  • Ditte Sloth Møller Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Science, Aarhus University, Aarhus, Denmark https://orcid.org/0000-0001-9910-515X

DOI:

https://doi.org/10.2340/1651-226X.2025.44013

Keywords:

Esophageal cancer, radiotherapy, morbidity, cancer survival, real world data

Abstract

Background and purpose: Standard treatment for esophageal (EC) and gastroesophageal junction (GEJ) cancer includes neoadjuvant chemo-radiotherapy (nCRT), followed by surgery or definitive chemo-radiotherapy (dCRT) for inoperable patients. This study assessed real-world survival and morbidity in EC patients treated with radiotherapy (RT).

Patient/material and methods: In this retrospective study, 417 patients with EC or GEJ cancer received nCRT or dCRT between 2012 and 2021 at a single center. We evaluated overall survival (OS), loco-regional control, progression-free survival, failure patterns, and toxicity.

Data were sourced from clinical and treatment records. Patients were treated following national guidelines and received intensity-modulated radiotherapy and daily cone-beam Computed Tomography (CT) for setup. Radiotherapy doses were 41.4–66 Gy in 23–33 fractions.

Results: Of the patients, 250 received nCRT, and 167 received dCRT. Most (86%) had T3-T4 tumors, and 65% had node-positive disease. Histologies were adenocarcinoma (50%) and squamous cell carcinoma (45%). A total of 88% completed RT, and 92.4% of nCRT patients proceeded to surgery. Median OS was 31 months for nCRT and 24 months for dCRT; 3-year OS was 46% and 38%, respectively. Disease recurrence occurred in 46% with a median interval of 20 months. Multivariable analysis identified OS-associated factors for both nCRT and dCRT. Acute toxicity was common but generally mild; late side effects were not systematically recorded.

Interpretation: In clinical practice, OS after nCRT or dCRT was as expected. Most patients undergoing nCRT proceeded to surgery. Toxicity was frequent but manageable.

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2025-10-15

How to Cite

Mortensen, H. R., Hoffmann, L., Nordsmark, M., Thorsen, L. B. J., & Møller, D. S. (2025). Real-world outcomes after concurrent chemo-radiotherapy in patients with locally advanced esophageal and gastroesophageal junction cancer. Acta Oncologica, 64, 1412–1419. https://doi.org/10.2340/1651-226X.2025.44013

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Vol. 64 (2025): Acta Oncologica

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Copyright (c) 2025 Hanna Rahbek Mortensen, Lone Hoffmann, Marianne Nordsmark, Lise Bech Jellesmark Thorsen, Ditte Sloth Møller

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