Perioperative chemotherapy versus neoadjuvant chemoradiotherapy for esophageal or GEJ adenocarcinoma: A propensity score‐matched analysis comparing toxicity, pathologic outcome, and survival

• Published in: Journal of surgical oncology Vol. 115; no. 7; pp. 812 - 820
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.06.2017
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - therapy; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Cancer surgery; capecitabin; Capecitabine - administration & dosage; carboplatin; Carboplatin - administration & dosage; chemoradiotherapy; Chemoradiotherapy - adverse effects; Chemotherapy; Chemotherapy, Adjuvant - adverse effects; cisplatin; Cisplatin - administration & dosage; Diarrhea - etiology; Disease Progression; epirubicin; Epirubicin - administration & dosage; esophageal adenocarcinoma; Esophageal cancer; Esophageal Neoplasms - mortality; Esophageal Neoplasms - therapy; Esophagectomy; Esophagogastric Junction - pathology; Esophagus; Female; Follow-Up Studies; gastroesophageal junction adenocarcinoma; Humans; Leukopenia - etiology; Male; Middle Aged; Neoadjuvant Therapy - adverse effects; Netherlands - epidemiology; paclitaxel; Paclitaxel - administration & dosage; Propensity Score; Radiation therapy; radiotherapy; Thromboembolism - etiology; paclitaxel; capecitabin; esophageal adenocarcinoma; carboplatin; radiotherapy; chemoradiotherapy; epirubicin; esophagectomy; cisplatin; gastroesophageal junction adenocarcinoma; chemotherapy
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.24596

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.