Comparison of neoadjuvant chemoradiation versus peri-operative chemotherapy for adenocarcinoma of the distal esophagus and gastroesophageal junction
| Autor: | Vivek R. Sharma, M.H. Bertke, Rebecca Redman, Robert C. G. Martin, Marie K. Gurka, Charles R. Scoggins |
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| Rok vydání: | 2017 |
| Předmět: | |
| Zdroj: | Journal of Clinical Oncology. 35:198-198 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.2017.35.4_suppl.198 |
| Popis: | 198 Background: Both neoadjuvant chemoradiation (NACRT) and peri-operative chemotherapy (PCTX) are viable treatment options when combined with surgical resection for locally advanced distal esophageal and gastroesophageal junction (GEJ) cancers. There is a paucity of data comparing these treatment regimens; therefore, the goal of this study was to compare the outcome of these two approaches at our institution. Methods: This is a retrospective review of a prospectively managed database, in which 66 patients with adenocarcinoma of the distal esophagus or GEJ who received either NACRT or PCTX from 2006 to 2015 were identified. Groups were balanced in regards to age, sex, subsite, T stage, and N stage. Patients treated with NACRT received either carboplatin/taxol or 5FU-based chemotherapy. PCTX regimens included ECF, EOX, DCF, or 5-FU based chemotherapy. Survival was calculated by the Kaplan–Meier method with a log‐rank test used for comparison between groups. Differences between subgroups were compared with Fisher’s Exact test. Results: A total of 47 patients were treated with NACRT and 19 with PCTX with a median follow-up of 14 months. All but three patients underwent definitive resection. No patients died within 90 days of surgery and the rate of operative complications was similar between the two groups (p = 0.77). The pathological complete response rate was 12.1% overall, with 14.9% in NACRT and 5.3% in PCTX. Median overall survival was 16.6 months and was not different between treatment subgroups (p = 0.77). Fewer treatment failures were seen with NACRT compared to PCTX (29.8% vs. 57.9%, p = 0.050), probably driven by improved local control in the NACRT arm (95.7% vs. 73.6%, p = 0.017). Distant failure was not significantly different between NACRT and PCTX (27.7% vs. 42.1%, p = 0.38). Conclusions: Pre-operative chemoradiation provided better overall disease control compared to peri-operative chemotherapy. However, improved survival could not be demonstrated, possibly due to the similar rates of distant failure and the study being underpowered due to small number of patients. |
| Databáze: | OpenAIRE |
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