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

Published inEuropean journal of surgical oncology, vol. 43, no. 8, p. 1572-1580
Publication date2017-08
First online date2017-06-16
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.

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Keywords
  • Adenocarcinoma
  • Chemoradiation
  • Chemotherapy
  • Oesophagectomy
  • Oesophagus
  • Prognosis
  • 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
Citation (ISO format)
FAVI, F et al. Neoadjuvant chemotherapy or chemoradiation for patients with advanced adenocarcinoma of the oesophagus? A propensity score-matched study. In: European journal of surgical oncology, 2017, vol. 43, n° 8, p. 1572–1580. doi: 10.1016/j.ejso.2017.06.003
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ISSN of the journal0748-7983
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