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The role of adjuvant platinum‐based chemotherapy in esophagogastric cancer patients who received neoadjuvant chemotherapy prior to definitive surgery
Author(s) -
Saunders John H.,
Bowman Christopher R.,
ReeceSmith Alex M.,
Pang Vincent,
Dorrington Matthew S.,
Mumtaz Errum,
Soomro Irshad,
Kaye Philip,
Madhusudan Srinivasan,
Parsons Simon L.
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.24601
Subject(s) - medicine , chemotherapy , oncology , adjuvant , hazard ratio , cancer , proportional hazards model , neoadjuvant therapy , surgery , breast cancer , confidence interval
Background and Objectives For patients with operable esophagogastric cancer, peri‐operative chemotherapy confers a significant overall survival benefit compared to surgery alone, however only 30‐40% of patients demonstrate histopathological response. It is unclear whether those with no neoadjuvant chemotherapy response should go onto receive adjuvant chemotherapy, as no further benefit may be conferred. Methods Esophagogastric cancers were prospectively captured with associated histopathological tumor regression grades following neoadjuvant chemotherapy. This cohort was then interrogated for clinico‐pathological and survival outcomes. Results Following neoadjuvant chemotherapy and surgery, patients with chemotherapy responsive cancers, who were administered adjuvant chemotherapy gained a significant overall survival benefit. Multivariate Cox analysis, demonstrated a final adjusted hazard ratio for adjuvant therapy of 0.509; (95%CI 0.28‐0.93); P = 0.028. In contrast, patients with non‐responsive tumors, who underwent adjuvant chemotherapy, did not show any survival benefit. Chemotherapy toxicity was prevalent and contributed to only half of patients receiving adjuvant chemotherapy. Conclusions These results suggest the benefit of the adjuvant portion of chemotherapy is limited to those who demonstrate a histopathological response to neoadjuvant chemotherapy. The administration of the adjuvant portion of chemotherapy to patients without a response to neoadjuvant chemotherapy may not provide any survival benefit, while potentially causing increased morbidity.