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Multimodal treatment of locally advanced esophageal adenocarcinoma: Which regimen should we choose? Outcome analysis of perioperative chemotherapy versus neoadjuvant chemoradiation in 105 patients
Author(s) -
Hoeppner Jens,
Zirlik Katja,
Brunner Thomas,
Bronsert Peter,
Kulemann Birte,
Sick Olivia,
Marjanovic Goran,
Hopt Ulrich Theodor,
Makowiec Frank
Publication year - 2014
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23498
Subject(s) - medicine , esophagectomy , perioperative , neoadjuvant therapy , adenocarcinoma , chemotherapy , esophageal adenocarcinoma , regimen , incidence (geometry) , surgery , esophageal cancer , survival rate , gastroenterology , cancer , physics , breast cancer , optics
Background The study was done to compare treatment and long‐term outcomes of neoadjuvant chemoradiation (neoCRT) and perioperative chemotherapy (periCTX) in patients with surgically treated esophageal adenocarcinoma. Methods An analysis of 105 patients with esophageal adenocarcinoma undergoing neoCRT (n = 58) or periCTX (n = 47) and esophagectomy between 2000 and 2012 was carried out. Results The overall median survival was 5.97 years. Postoperative morbidity and in‐hospital mortality occurred in 74%/7% of the patients the neoCRT group and in 53%/0% of the patients in the periCTX group ( P = 0.03/ P = 0.08). Total or subtotal histological tumor response after neoadjuvant treatment and esophagectomy was found in 59% after neoCRT and 30% after periCTX ( P < 0.01). Three‐ and five‐year survival rates were 52%/45% for neoCRT and 68%/63% for periCTX ( P = 0.05). PeriCTX was identified as an independent predictor of survival (RR2.6; 95% CI 1.3–5.1; P < 0.01). Conclusion A higher rate of histologic response to neoCRT compared to histologic response following the preoperative cycles of periCTX does not translate to a benefit in overall survival. PeriCTX offers a decreased incidence of treatment‐related morbidity and mortality and at least equal results in terms of survival compared to neoCRT in patients with locally advanced esophageal adenocarcinoma. J. Surg. Oncol. 2014 109:287–293 . © 2013 Wiley Periodicals, Inc.