Neoadjuvant Chemotherapy Vs Chemoradiotherapy for Malignancy of Oesophagus (NAMO Study)

Abstract Background Neoadjuvant chemoradiation (NACRT) followed by surgery has become the standard of care in the management of oesophageal cancer. This study was intended to compare the neoadjuvant chemotherapy (NACT) with NACRT for squamous cell carcinoma (SCC) of the oesophagus in terms of tolerability and oncological benefit. Methods A non-randomised controlled study was conducted from July 2019 to August 2023. Either NACT or NACRT was given to all resectable oesophagus cancer (Clinical staged IB–IIIC) patients based on their choice after counselling and proper consent. Post neoadjuvant therapy, all patients underwent Mckeown’s esophagectomy with two-field lymphadenectomy. Radiological and pathological response, peri-operative morbidity, mortality, recurrence-free and overall survival were compared. Results Out of 75 patients enrolled, after exclusion, 30 patients had received NACT, and 33 received NACRT. The pre-operative demographics, clinical tumor & nodal stage and post-neoadjuvant therapy-related adverse events were comparable in the two groups. The median number of LNs retrieved (21 vs 19, p = 0.19), R0 resection rate (100% vs 94%) and perineural invasion were similar (36.7% vs 24.2%, p-value: 0.283) in both. Although the pathological response was significantly better in the NACRT arm at a median follow-up of 32.5 (20.75–48) months, the median recurrence-free survival was higher in the NACT than the NACRT group (57 vs 36 months, p-value – 0.831), and overall survival was yet to reach in both groups. Conclusions NACT has non-inferior oncological and survival outcomes vis a-vis patients receiving NACRT. NACT could be a feasible alternative to NACRT in SCC of the oesophagus, especially in situations where radiotherapy is not feasible.