The Impact of Neoadjuvant Chemoradiation Therapy on Non-Tumorous Barrett’s Dysplasia of the Esophagus: A Multicenter Cohort Study

<b>Background/Objectives</b>: Barrett's esophagus (BE) is a precursor to esophageal adenocarcinoma (EAC), and neoadjuvant chemoradiation therapy (NCRT) is commonly used in the treatment of EAC. However, the impact of NCRT on non-tumorous BE and dysplasia is poorly understood. Our study aims to evaluate the effects of NCRT on BE segment length and dysplasia in patients undergoing esophagectomy for EAC. <b>Methods</b>: This multicenter, retrospective cohort study includes EAC patients who underwent esophagectomy with or without NCRT between 2014 and 2020. Patients with histologically confirmed BE and dysplasia (low- or high-grade) were analyzed. Preoperative and postoperative pathology were compared to assess BE regression, dysplastic changes, and segment length. Statistical analyses included chi-square and <i>t</i>-tests, with <i>p</i> < 0.05 considered significant. <b>Results</b>: Of 101 patients who were diagnosed with EAC, 28 patients were found to have BE, with 18 receiving NCRT in addition to surgery and 10 undergoing surgery alone. The NCRT group showed significantly higher BE regression than the control group (77.8% versus 10%, <i>p</i> < 0.001). Regression of dysplasia occurred in 66.7% of the NCRT group versus 20% of the control group (<i>p</i> = 0.079) and residual dysplasia was lower in the NCRT group (33.3%) compared to the control group (80%) (<i>p</i> = 0.018). <b>Conclusions</b>: NCRT significantly reduces BE and dysplasia, suggesting it may improve surgical outcomes by minimizing residual disease. These findings support the potential of NCRT to enhance surgical precision in EAC treatment, though further research is needed to explore underlying mechanisms and refine treatment strategies.