To assess whether the patients treated by tri-modality treatment fulfil the eligibility criteria of the actual protocol.
A compliance audit was carried out by querying the electronic databases for prospectively recorded patients undergoing tri-modality treatment. The patient characteristics and outcome were compared against the eligibility criteria of the CROSS regimen. Analysis has been done by Descriptive statistics.
Between 2014-15, a total of 65 patients with oesophageal cancers were discussed in the Gastro-intestinal Multi-disciplinary team (GIMDT). In all, 23 patients had tri-modality treatment. 14 of these are included in this study. Rest were treated with more aggressive neoadjuvant regimes. On endoscopy, the tumours ranged from 2-10 cm. Endoscopic Ultrasound was not routinely performed as all patients had a PET scan and advanced disease. Pulmonary function assessment was variable. Variation in the patient selection as compared to the CROSS regime was noted for age, pre-treatment work up, and the length of the tumour. Chemo-radiotherapy was delivered without any breaks or dose reductions. Surgical complications noted were of similar to that reported in the publication. 3/14 patients would not have been eligible for the trial protocol but were treated by consensus of the GIMDT as the variations were considered minor. All three had significant complications. There were 2 deaths within 90 days, one immediate post-op and the other due to complications as a result of a volvulus. The former patient had significant co-morbidities but was cleared for surgery on anaesthetic review, while the later had unrecognised metastatic disease. Within the short follow-period, another 4 deaths has occurred due to disease relapse.Interestingly, the more aggressively treated group with similar co-morbidities did not have any 90-day mortality.
Most of the treated patients complied with the CROSS protocol. Variation in approach should considered carefully within the confines of a GIMDT. However, since the benefit is not across all patient groups, controlled phase 4 studies are needed to determine optimal management for patients ineligible as per the CROSS protocol.