Induction Radiochemotherapy for Esophageal Cancer: Long-Term Outcomes from a Single-Center Study

<b>Background/Objectives:</b> The management of esophageal cancer (EC) remains a significant clinical challenge, particularly in optimizing therapeutic strategies for different stages and subgroups. This study assessed the impact of preoperative radiochemotherapy (CRT) on clinical staging and identified subgroups for whom definitive CRT (dCRT) may provide a favorable alternative to surgery. <b>Methods:</b> Sixty-one patients with esophageal adenocarcinoma or squamous cell carcinoma were enrolled. Pre-treatment staging included computed tomography, gastroscopy with biopsy, and comprehensive laboratory evaluations. Patients received preoperative CRT following the CROSS or dCRT protocols based on tumor stage. Surgical approaches included staged esophagectomy or single-stage Ivor Lewis procedures. Four patients declined surgery and were treated with dCRT. Postoperative outcomes were evaluated using pTNM classification. Follow-up included imaging and endoscopic surveillance. Statistical analyses assessed changes in staging and factors influencing treatment outcomes. <b>Results:</b> CRT significantly reduced T stage across the entire cohort (<i>p</i> = 0.0002), with complete pathological response (pT0N0M0) observed in 54.5% of patients following induction CRT (<i>p</i> = 0.0001). Male patients demonstrated a significant reduction in T stage (<i>p</i> = 0.0008), while a similar trend in females was not significant (<i>p</i> = 0.068). Among patients declining surgery, dCRT demonstrated acceptable oncologic control over a mean follow-up of 4 ± 0.79 years. <b>Conclusions:</b> Preoperative CRT effectively downstages EC and achieves high rates of response, especially in male patients. Therefore, dCRT may be a viable alternative in selected patients, emphasizing the need for individualized treatment strategies to optimize outcomes. These findings underscore the importance of refining multimodal approaches in EC care.