Patterns of Recurrence After Surgery Alone Versus Preoperative Chemoradiotherapy and Surgery in the CROSS Trials

• Published in: Journal of clinical oncology Vol. 32; no. 5; pp. 385 - 391
• Main Authors: OPPEDIJK, Vera, VAN DER GAAST, Ate, REINDERS, Janny G, RICHEL, Dick J, VAN BERGE HENEGOUWEN, Mark I, HULSHOF, Maarten C. C. M, VAN LANSCHOT, Jan J. B, VAN HAGEN, Pieter, VAN OS, Rob, VAN RIJ, Caroline M, VAN DER SANGEN, Maurice J, BEUKEMA, Jannet C, RÜTTEN, Heidi, SPRUIT, Patty H
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 10.02.2014
• Subjects: Adenocarcinoma - secondary; Adenocarcinoma - therapy; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carboplatin - administration & dosage; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - therapy; Chemotherapy, Adjuvant - adverse effects; Dose Fractionation; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophagectomy - adverse effects; Esophagogastric Junction - drug effects; Esophagogastric Junction - pathology; Esophagogastric Junction - radiation effects; Esophagogastric Junction - surgery; Female; Gastrectomy - adverse effects; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Multivariate Analysis; Neoadjuvant Therapy - adverse effects; Neoplasm Recurrence, Local - prevention & control; Paclitaxel - administration & dosage; Proportional Hazards Models; Risk Factors; Stomach Neoplasms - pathology; Stomach Neoplasms - therapy; Time Factors; Treatment Outcome; Tumors; Relapse; Cancerology; Treatment; Surgery; Clinical trial; Preoperative; Chemoradiotherapy; Comparative study
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2013.51.2186

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. 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. 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. 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.