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

F Favi; E Bollschweiler; F Berlth; P Plum; D A Hescheler; H Alakus; R Semrau; E Celik; S P Mönig; U Drebber; A H Hölscher

doi:10.1016/j.ejso.2017.06.003

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

Eur J Surg Oncol. 2017 Aug;43(8):1572-1580. doi: 10.1016/j.ejso.2017.06.003. Epub 2017 Jun 16.

Authors

F Favi¹, E Bollschweiler², F Berlth¹, P Plum¹, D A Hescheler¹, H Alakus¹, R Semrau³, E Celik³, S P Mönig⁴, U Drebber⁵, A H Hölscher⁶

Affiliations

¹ Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
² Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany. Electronic address: ebollsch@uni-koeln.de.
³ Department of Radiation Oncology, University of Cologne, Cologne, Germany.
⁴ Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany; Service de Chirurgie Viscéral, Hôpitaux Universitaires de Genève, Switzerland.
⁵ Institute of Pathology, University of Cologne, Cologne, Germany.
⁶ Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany; Department of Surgery, AGAPLESION Markus Krankenhaus, Frankfurt, Germany.

PMID: 28666624
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 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.

Keywords: Adenocarcinoma; Chemoradiation; Chemotherapy; Oesophagectomy; Oesophagus; Prognosis.

Publication types

Comparative Study

MeSH terms

Adenocarcinoma / therapy*
Chemoradiotherapy*
Chemotherapy, Adjuvant*
Esophageal Neoplasms / therapy*
Esophagectomy
Female
Humans
Lymph Node Excision
Male
Middle Aged
Neoadjuvant Therapy
Prognosis
Propensity Score
Retrospective Studies
Survival Rate
Treatment Outcome