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Perioperative chemotherapy versus neoadjuvant chemoradiotherapy for esophageal or GEJ adenocarcinoma: A propensity score‐matched analysis comparing toxicity, pathologic outcome, and survival
Author(s) -
Goense Lucas,
van der Sluis Pieter C.,
van Rossum Peter S. N.,
van der Horst Sylvia,
Meijer Gert J.,
Haj Mohammad Nadia,
van Vulpen Marco,
Mook Stella,
Ruurda Jelle P.,
van Hillegersberg Richard
Publication year - 2017
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.24596
Subject(s) - medicine , epirubicin , perioperative , propensity score matching , capecitabine , neoadjuvant therapy , chemoradiotherapy , esophagectomy , adenocarcinoma , chemotherapy , carboplatin , surgery , gastroenterology , oncology , esophageal cancer , cisplatin , cancer , cyclophosphamide , colorectal cancer , breast cancer
Objectives To evaluate toxicity, pathologic outcome, and survival after perioperative chemotherapy (pCT) compared to neoadjuvant chemoradiotherapy (nCRT) followed by surgery for patients with resectable esophageal or gastroesophageal junction (GEJ) adenocarcinoma. Methods Consecutive patients with resectable esophageal or GEJ adenocarcinoma who underwent pCT (epirubicin, cisplatin, and capecitabine) or nCRT (paclitaxel, carboplatin, and 41.4 Gy) followed by surgery in a tertiary referral center in the Netherlands were compared. Propensity score matching was applied to create comparable groups. Results Of 193 eligible patients, 21 were discarded after propensity score matching; 86 and 86 patients who underwent pCT and nCRT, respectively, remained. Grade ≥3 thromboembolic events occurred only in the pCT group (19% vs. 0%, P < 0.001), whereas grade ≥3 leukopenia occurred more frequently in the nCRT group (14% vs. 4%, P = 0.015). No significant differences regarding postoperative morbidity and mortality were found. Pathologic complete response was more frequently observed with nCRT (18% vs. 11%, P < 0.001), without significantly improving radicality rates (95% vs. 89%, P = 0.149). Both strategies resulted in comparable 3‐year progression‐free survival (pCT vs. nCRT: 46% vs. 55%, P = 0.344) and overall survival rates (49% vs. 50%, P = 0.934). At 3‐year follow‐up, fewer locoregional disease progression occurred in the nCRT group (19% vs. 37%, P = 0.024). Conclusions Compared to perioperative chemotherapy, neoadjuvant chemoradiotherapy achieves higher pathologic response rates and a lower risk of locoregional disease progression, without improving survival.