154 Patient Choice of Surgery or Active Surveillance for Oesophageal Cancer After a Clinical Complete Response to Neoadjuvant Chemoradiotherapy

Abstract Background Patients are increasingly encouraged to take an active role in their healthcare decision-making, but this has yet to extend to those with clinical complete response (cCR) to neoadjuvant chemoradiation therapy (NCR) in oesophageal cancer. Over half of oesophageal cancer patients achieve a cCR to NCR, with the majority also showing a pathological complete response. Current guidelines mandate resection, even for those with cCR. Should the resected oesophagus show no residual cancer the question of overtreatment arises, particularly when the morbidity and mortality of oesophagectomy are considered. Aims This study examines the outcome of a novel protocol offering cCR patients a choice between surgery or active surveillance. We hypothesised that this protocol would not produce a significant difference in survival between groups. Methods and Results Of 152 oesophageal cancer patients who received NCR, 80 (52%) had a cCR; of which 51 (63.75%; mean age 58-years) chose surgery and 29 (36.25%; mean age 70-years) chose active surveillance. Seven patients (24.1%) in the surveillance cohort developed a recurrence in the oesophagus, of whom, 6 underwent salvage oesophagectomy. The active surveillance cohort were more likely to be alive at 12 months, with the surgery cohort demonstrating a 17% higher mortality at 12 months. Over a 5-year follow-up period, and adjusted for age, the mean survival of the active surveillance cohort was 37.0 months (95% CI 26.3 - 47.6) and for the surgery cohort was 37.2 months (95% CI 29.7 - 44.6). Conclusion Our results support patient choice for oesophageal cancer patients with cCR to NCR.