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Background <p>Esophageal cancers ranked the sixth leading cause of cancer-related mortality, pose a significant health challenge in India. Neo-adjuvant chemoradiotherapy (NACTRT) followed by surgery is the current standard, yet its outcomes among Indian patients remains unclear. Many patients receiving NACTRT default therapy or do not proceed with the surgical procedure due to various factors. Our aim in this study was to elucidate the diverse factors contributing to this phenomenon and obtain a comprehensive understanding of the issue.</p> Methodology <p>This analysis was done on the data of esophageal cancer patients treated at our institute, between January 2019 and December 2023. The study included the patients with biopsy-proven, non-metastatic squamous cell carcinoma/ adenocarcinoma of the middle and lower third esophagus, ranging from cT1 to T4 and N0 to N3 stages, who underwent NACTRT as per our institutional protocol. Data from electronic databases and patient case-sheets, supplemented by telephonic interviews, provided insights into the treatment outcomes and reasons for treatment discontinuation.</p> Results <p>Of 227 patients receiving NACTRT, 81 (35.7%) did not undergo surgery. The most common reasons for default were poor performance status in 23 patients (10.1%), death during or shortly after NACTRT in 18 (7.9%), disease progression in 18 (7.9%), patient refusal in 13 (5.7%), and intraoperative inoperable/metastatic disease in 9 (3.9%).</p> Conclusion <p>Successful delivery of neoadjuvant therapy in India requires careful patient selection and the use of advanced imaging modalities such as PET-CT to ensure accurate staging and treatment planning. Structured prehabilitation programs that include tailored nutritional support and pulmonary rehabilitation can enhance physical fitness and treatment tolerance, while comprehensive pretreatment counselling supports better adherence to the therapeutic plan. By integrating these patient-centric interventions into clinical practice, healthcare teams can improve treatment completion rates and optimize clinical outcomes in the evolving neoadjuvant care landscape.</p>

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Reasons for Non-Completion of Surgery after Neoadjuvant Chemoradiotherapy in Esophageal Cancer: A Real-World Retrospective Analysis from a Tertiary Cancer Centre

  • 期刊论文

  • 发表日期：

    2026年5月4日

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  • Sankhya Bhat S,
  • Ketul S Puj,
  • Aashish Sharma K,
  • Mohit Sharma,
  • Niranjan Kumar Dash,
  • Harsha Panchal,
  • Rujuta A Shah,
  • Shashank J Pandya

摘要

Background

Esophageal cancers ranked the sixth leading cause of cancer-related mortality, pose a significant health challenge in India. Neo-adjuvant chemoradiotherapy (NACTRT) followed by surgery is the current standard, yet its outcomes among Indian patients remains unclear. Many patients receiving NACTRT default therapy or do not proceed with the surgical procedure due to various factors. Our aim in this study was to elucidate the diverse factors contributing to this phenomenon and obtain a comprehensive understanding of the issue.

Methodology

This analysis was done on the data of esophageal cancer patients treated at our institute, between January 2019 and December 2023. The study included the patients with biopsy-proven, non-metastatic squamous cell carcinoma/ adenocarcinoma of the middle and lower third esophagus, ranging from cT1 to T4 and N0 to N3 stages, who underwent NACTRT as per our institutional protocol. Data from electronic databases and patient case-sheets, supplemented by telephonic interviews, provided insights into the treatment outcomes and reasons for treatment discontinuation.

Results

Of 227 patients receiving NACTRT, 81 (35.7%) did not undergo surgery. The most common reasons for default were poor performance status in 23 patients (10.1%), death during or shortly after NACTRT in 18 (7.9%), disease progression in 18 (7.9%), patient refusal in 13 (5.7%), and intraoperative inoperable/metastatic disease in 9 (3.9%).

Conclusion

Successful delivery of neoadjuvant therapy in India requires careful patient selection and the use of advanced imaging modalities such as PET-CT to ensure accurate staging and treatment planning. Structured prehabilitation programs that include tailored nutritional support and pulmonary rehabilitation can enhance physical fitness and treatment tolerance, while comprehensive pretreatment counselling supports better adherence to the therapeutic plan. By integrating these patient-centric interventions into clinical practice, healthcare teams can improve treatment completion rates and optimize clinical outcomes in the evolving neoadjuvant care landscape.