Neoadjuvant chemotherapy or chemoradiation for patients with advanced adenocarcinoma of the oesophagus? A propensity score-matched study

• Published in: European journal of surgical oncology 2017-08, Vol.43 (8), p.1572-1580
• Main Authors: Favi, Francesco, Bollschweiler, E, Berlth, F, Plum, P, Hecheler, D, Alakus H, H, Semrau, R, Celik, E, Mönig, S.P, Drebber, U, Hölscher, A.H
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma - therapy; Chemoradiation; Chemoradiotherapy; Chemotherapy; Chemotherapy, Adjuvant; Esophageal Neoplasms - therapy; Esophagectomy; Female; Hematology, Oncology and Palliative Medicine; Humans; Lymph Node Excision; Male; Middle Aged; Neoadjuvant Therapy; Oesophagectomy; Oesophagus; Prognosis; Propensity Score; Retrospective Studies; Surgery; Survival Rate; Treatment Outcome
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2017.06.003

Abstract Background Multimodal therapies are the standard of care for advanced adenocarcinomas of the oesophagus and gastro-oesophageal junction (AEG Types I and II). Only three randomised trials have compared preoperative chemotherapy with and without radiation. The results showed a small benefit for combined chemoradiation. In the meantime, newer therapy protocols are available. Aim In a propensity-score matched study, we analysed patients with locally advanced AEG type I or II, treated with chemotherapy (FLOT-protocol) or chemoradiation (CROSS-protocol), followed by oesophagectomy, in a single high-volume centre. Patients and Methods Between 2011 and 2015, 137 patients with advanced (cT3NxcM0) adenocarcinoma AEG type I or II received pre-operative therapy; 70% had chemoradiation (CROSS-protocol) and 30% had chemotherapy (FLOT-protocol). After propensity-score matching, 40 patients from the CROSS-group were selected for analysis. Postoperative histopathological response and prognosis were analysed. Results The two groups were comparable according to the matching criteria age, gender, tumour location, and year of surgery. R0-resection was achieved in 97% of patients in the CROSS-group and 85% of the FLOT-group (p=0.049). Major response of the primary tumour was evident more often in the CROSS-group (17/40 pts. 43%) versus FLOT-group (11/40 pts. 27%) as well no lymph node metastasis (ypN0=68% versus ypN0=40%) (p=0.014). Prognosis were not significantly different between the two groups. In multivariate analysis, only ypN-category was an independent prognostic factor. Conclusion Compared to FLOT-chemotherapy, neoadjuvant chemoradiotherapy with the CROSS-protocol in locally advanced adenocarcinoma AEG types I and II resulted in better response by the primary tumour and less lymph node metastasis but without superior survival.