Abstract

Background: Carcinoma of the esophagus, particularly middle one-third, presents unique treatment challenges. This study evaluates long-term survival outcomes and treatment-related toxicity in patients with medically inoperable esophageal carcinoma treated with induction chemotherapy followed by concurrent chemoradiation. Methods: A retrospective analysis was conducted at a tertiary care hospital on patients diagnosed with carcinoma esophagus (middle one-third) from 2015 to 2020. Patients were selected based on medical inoperability and received a standard regimen of induction chemotherapy followed by concurrent chemoradiotherapy. Data on demographics, tumor characteristics, treatment response, survival, and toxicities were analyzed. Results: Of the cohort (n=50), 74% were aged between 41 and 60 years with male pre dominance. Most tumors were moderately differentiated squamous cell carcinomas presenting with proliferative-ulcerative morphology and tumor length ranging from 5 to 10 cm. All patients received induction chemotherapy followed by 56 –60 Gy radiotherapy with concurrent cisplatin-based chemotherapy. Thirtytwo (64%) patients survived beyond two years, and six (12%) achieved a five-year survival. Acute toxicities included Grade II–III esophagitis in 36% of patients, while long-term toxicities such as strictures were observed in 10%. No Grade IV hematologic toxicities were reported. All patients had symptomatic relief in swallowing function during the second week of treatment. Conclusion: The treatment approach of induction chemotherapy followed by concurrent chemoradiation demonstrated early symptom relief and encouraging long-term survival in medically inoperable patients with middle-third esophageal carcinoma. Careful patient selection and supportive care can mitigate toxicity, making this regime a viable non-surgical alternative.

• 1.   Devesa S.S., Blot W.J., Fraumeni J.F. Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer. 1998 Nov 15; 83(10): 2049–53.
• 2.   Virendra Bhandari, Lodi Ashar, Pooja Handaetal. Long Term Survival and Late Toxicities in Inoperable Carcinoma Esophagus Treated wth Concurrent Chemotherapy and Radiotherapy. Indian JCancEducRes. 2019; 7(1): 5-12.
• 3.   Botterweck A.A., Schouten L.J., Volovics A., Dorant E., van Den Brandt P.A. Trends in incidence of adenocarcinoma of the oesophagus and gastric cardia in ten European countries. Int J Epidemiol. 2000 Aug; 29(4): 645–54.
• 4.   Shaheen N., Ransohoff D.F. Gastroesophageal reflux, barrett esophagus, and esophageal cancer: scientific review. JAMA. 2002 Apr 17; 287(15): 1972–81.
• 5.   Gillison M.L., Shah K.V. Chapter 9: Role of mucosal human papillomavirus in nongenital cancers. J Natl Cancer Inst Monogr. 2003; 2003(31): 57–65.
• 6.   Krishnamurthy A., Behuria S.S. Demographic trends in carcinoma esophagus from India along with a brief comparative review of the global trends. South Asian J Cancer. 2020 Jul; 9(3): 163–7.
• 7.   Samarasam I. Esophageal cancer in India: Current status and future perspectives. Int J Adv Med Health Res. 2017;4(1):5.
• 8.   Wang Y., Mukkamalla S.K.R., Singh R., Lyons S. Esophageal cancer. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.
• 9.   Schuchert M.J., Luketich J.D. Management of Barrett’s esophagus. Oncology (Williston Park). 2007 Oct; 21(11): 1382–9, 1392; discussion 1392, 1394, 1396.
• 10.   Wani S., Rubenstein J.H., Vieth M., Bergman J. Diagnosis and management of low-grade dysplasia in Barrett’s esophagus: Expert review from the clinical practice updates committee of the American gastroenterological association. Gastroenterology. 2016 Nov; 151(5): 822–35.
• 11.   Shaheen N.J., Falk G.W., Iyer P.G., Gerson L.B. American College of Gastroenterology. ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus. Am J Gastroenterol. 2016; 111(1): 30–50.
• 12.   Amin M.B., Greene F.L., Edge S.B., Compton C.C., Gershenwald J.E., Brookland R.K., et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017 Mar; 67(2): 93–9.
• 13.   O’Sullivan B., Brierley J., Byrd D., Bosman F., Kehoe S., Kossary C., et al. The TNM classification of malignant tumours-towards common understanding and reasonable expectations. Lancet Oncol. 2017 Jul; 18(7): 849–51.
• 14.   Battaglin F., Naseem M., Puccini A., Lenz H.J. Molecular biomarkers in gastro-esophageal cancer: Recent developments, current trends and future directions. Cancer Cell Int. 2018 Jul 11; 18(1): 99.
• 15.   Lewis, G. et al. (2021). Translanguaging: Developing Its Conceptualisation and Contextualization. Educational Research and Evaluation, No. 7, 655-670.
• 16.   Xia X., Wu M., Gao Q., Sun X., Ge X. Consolidation chemotherapy rather than induction chemotherapy can prolong the survival rate of inoperable esophageal cancer patients who received concurrent chemoradiotherapy. Curr Oncol. 2022 Sep 2; 29(9): 6342–9.
• 17.   Luo L.L., Xi M., Yang Y.D., Li Q.Q., Zhao L., Zhang P., et al. Comparative outcomes of induction chemotherapy followed by definitive chemoradiotherapy versus chemoradiotherapy alone in esophageal squamous cell carcinoma. J Cancer. 2017 Sep 20; 8(17): 3441–7.
• 18.   Simoni N., Pavarana M., Micera R., Weindelmayer J., Mengardo V., Rossi G., et al. Long-term outcomes of induction chemotherapy followed by chemoradiotherapy as intensive neoadjuvant protocol in patients with esophageal cancer. Cancers (Basel). 2020 Dec 3; 12(12): 3614.

Data Sharing Statement

Funding