TO DETERMINE THE FREQUENCY OF COMPLETE PATHOLOGICAL RESPONSE IN RESECTABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS TREATED WITH INDUCTION CHEMOTHERAPY FOLLOWED BY CONCURRENT CHEMORADIATION AND SURGERY

Abstract

Background: Esophageal squamous cell carcinoma is an aggressive malignancy associated with poor prognosis and high mortality.

Objective: To determine the frequency of pathological complete response in patients with resectable esophageal squamous cell carcinoma treated with induction chemotherapy followed by concurrent chemoradiotherapy and surgery.

Methods: This prospective observational study was conducted at the Department of Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar, from June 2025 to November 2025. A total of 116 patients aged 30–70 years with histologically confirmed resectable esophageal squamous cell carcinoma (T1–T3, N0–N1, M0) were included through non-probability convenience sampling. Baseline demographic, clinical, and tumor-related characteristics were recorded. Patients underwent induction chemotherapy followed by concurrent chemoradiotherapy and definitive surgery.

Results: The mean age was 54.8 ± 9.6 years, with male predominance (68.1%). Most patients presented with T3 disease (56.0%) and nodal involvement (62.1%). Pathological complete response was achieved in 38 (32.8%) patients, while R0 resection was achieved in 101 (87.1%). Patients achieving pathological complete response were significantly younger (51.2 ± 8.7 vs. 56.5 ± 9.8 years; p=0.006) and more likely to have ECOG 0–1 status (78.9% vs. 55.1%; p=0.01), earlier tumor stage (p<0.001), N0 disease (p=0.003), and favorable histological differentiation (p=0.01). Treatment-related toxicity occurred in 52.6% of patients, most commonly fatigue (36.2%), nausea/vomiting (29.3%), and esophagitis (25.0%).

Conclusion: Induction chemotherapy followed by concurrent chemoradiotherapy and surgery demonstrated favorable pathological response and high surgical clearance rates in resectable esophageal squamous cell carcinoma, with acceptable tolerability, supporting its role as an effective multimodal treatment strategy.