Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials.

Autor:	Oppedijk V; Vera Oppedijk, Rob van Os, Dick J. Richel, Mark I. van Berge Henegouwen, and Maarten C.C.M. Hulshof, Academic Medical Center, Amsterdam; Patty H. Spruit, Vrije Universiteit Medical Center, Amsterdam; Ate van der Gaast, Jan J.B. van Lanschot, Pieter van Hagen, and Caroline M. van Rij, Erasmus Medical Center, Rotterdam; Maurice J. van der Sangen, Catharina Hospital, Eindhoven; Jannet C. Beukema, University Medical Center, Groningen; Heidi Rütten, Radboud University Medical Center, Nijmegen; and Janny G. Reinders, Arnhems Radiotherapeutisch Instituut, Arnhem, the Netherlands., van der Gaast A, van Lanschot JJ, van Hagen P, van Os R, van Rij CM, van der Sangen MJ, Beukema JC, Rütten H, Spruit PH, Reinders JG, Richel DJ, van Berge Henegouwen MI, Hulshof MC
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2014 Feb 10; Vol. 32 (5), pp. 385-91. Date of Electronic Publication: 2014 Jan 13.
DOI:	10.1200/JCO.2013.51.2186
Abstrakt:	Purpose: To analyze recurrence patterns in patients with cancer of the esophagus or gastroesophageal junction treated with either preoperative chemoradiotherapy (CRT) plus surgery or surgery alone. Patients and Methods: Recurrence pattern was analyzed in patients from the previously published CROSS I and II trials in relation to radiation target volumes. CRT consisted of five weekly courses of paclitaxel and carboplatin combined with a concurrent radiation dose of 41.4 Gy in 1.8-Gy fractions to the tumor and pathologic lymph nodes with margin. Results: Of the 422 patients included from 2001 to 2008, 418 were available for analysis. Histology was mostly adenocarcinoma (75%). Of the 374 patients who underwent resection, 86% were allocated to surgery and 92% to CRT plus surgery. On January 1, 2011, after a minimum follow-up of 24 months (median, 45 months), the overall recurrence rate in the surgery arm was 58% versus 35% in the CRT plus surgery arm. Preoperative CRT reduced locoregional recurrence (LRR) from 34% to 14% (P < .001) and peritoneal carcinomatosis from 14% to 4% (P < .001). There was a small but significant effect on hematogenous dissemination in favor of the CRT group (35% v 29%; P = .025). LRR occurred in 5% within the target volume, in 2% in the margins, and in 6% outside the radiation target volume. In 1%, the exact site in relation to the target volume was unclear. Only 1% had an isolated infield recurrence after CRT plus surgery. Conclusion: Preoperative CRT in patients with esophageal cancer reduced LRR and peritoneal carcinomatosis. Recurrence within the radiation target volume occurred in only 5%, mostly combined with outfield failures.
Databáze:	MEDLINE
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