F Favi1, E Bollschweiler2, F Berlth1, P Plum1, D A Hescheler1, H Alakus1, R Semrau3, E Celik3, S P Mönig4, U Drebber5, A H Hölscher6. 1. Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany. 2. Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany. Electronic address: ebollsch@uni-koeln.de. 3. Department of Radiation Oncology, University of Cologne, Cologne, Germany. 4. Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany; Service de Chirurgie Viscéral, Hôpitaux Universitaires de Genève, Switzerland. 5. Institute of Pathology, University of Cologne, Cologne, Germany. 6. Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany; Department of Surgery, AGAPLESION Markus Krankenhaus, Frankfurt, Germany.
Abstract
BACKGROUND: Multimodal therapies are the standard of care for advanced adenocarcinomas of the oesophagus and gastro-oesophageal junction (AEG Types I and II). Only three randomised trials have compared preoperative chemotherapy with and without radiation. The results showed a small benefit for combined chemoradiation. In the meantime, newer therapy protocols are available. AIM: In a propensity-score matched study, we analysed patients with locally advanced AEG type I or II, treated with chemotherapy (FLOT-protocol) or chemoradiation (CROSS-protocol), followed by oesophagectomy, in a single high-volume centre. PATIENTS AND METHODS: Between 2011 and 2015, 137 patients with advanced (cT3NxcM0) adenocarcinoma received pre-operative therapy; 70% had chemoradiation (CROSS-protocol) and 30% had chemotherapy (FLOT-protocol). After propensity-score matching, 40 patients from the CROSS-group were selected for analysis. Postoperative histopathological response and prognosis were analysed. RESULTS: The two groups were comparable according to the matching criteria age, gender, tumour location, and year of surgery. R0-resection was achieved in 97% of patients in the CROSS-group and 85% of the FLOT-group (p = 0.049). Major response of the primary tumour was evident more often in the CROSS-group (17/40 pts. 43%) versus FLOT-group (11/40 pts. 27%) as well no lymph node metastasis (ypN0 = 68% versus ypN0 = 40%) (p = 0.014). Prognosis were not significantly different between the two groups. In multivariate analysis, only ypN-category was an independent prognostic factor. CONCLUSION: Compared to FLOT-chemotherapy, neoadjuvant chemoradiotherapy with the CROSS-protocol in locally advanced adenocarcinoma AEG types I and II resulted in better response by the primary tumour and less lymph node metastasis but without superior survival.
BACKGROUND: Multimodal therapies are the standard of care for advanced adenocarcinomas of the oesophagus and gastro-oesophageal junction (AEG Types I and II). Only three randomised trials have compared preoperative chemotherapy with and without radiation. The results showed a small benefit for combined chemoradiation. In the meantime, newer therapy protocols are available. AIM: In a propensity-score matched study, we analysed patients with locally advanced AEG type I or II, treated with chemotherapy (FLOT-protocol) or chemoradiation (CROSS-protocol), followed by oesophagectomy, in a single high-volume centre. PATIENTS AND METHODS: Between 2011 and 2015, 137 patients with advanced (cT3NxcM0) adenocarcinoma received pre-operative therapy; 70% had chemoradiation (CROSS-protocol) and 30% had chemotherapy (FLOT-protocol). After propensity-score matching, 40 patients from the CROSS-group were selected for analysis. Postoperative histopathological response and prognosis were analysed. RESULTS: The two groups were comparable according to the matching criteria age, gender, tumour location, and year of surgery. R0-resection was achieved in 97% of patients in the CROSS-group and 85% of the FLOT-group (p = 0.049). Major response of the primary tumour was evident more often in the CROSS-group (17/40 pts. 43%) versus FLOT-group (11/40 pts. 27%) as well no lymph node metastasis (ypN0 = 68% versus ypN0 = 40%) (p = 0.014). Prognosis were not significantly different between the two groups. In multivariate analysis, only ypN-category was an independent prognostic factor. CONCLUSION: Compared to FLOT-chemotherapy, neoadjuvant chemoradiotherapy with the CROSS-protocol in locally advanced adenocarcinomaAEG types I and II resulted in better response by the primary tumour and less lymph node metastasis but without superior survival.
Authors: Benjamin P Sharpe; Annette Hayden; Antigoni Manousopoulou; Andrew Cowie; Robert C Walker; Jack Harrington; Fereshteh Izadi; Stella P Breininger; Jane Gibson; Oliver Pickering; Eleanor Jaynes; Ewan Kyle; John H Saunders; Simon L Parsons; Alison A Ritchie; Philip A Clarke; Pamela Collier; Nigel P Mongan; David O Bates; Kiren Yacqub-Usman; Spiros D Garbis; Zoë Walters; Matthew Rose-Zerilli; Anna M Grabowska; Timothy J Underwood Journal: Cell Rep Med Date: 2022-06-21
Authors: Oliver O Koch; Michael Weitzendorfer; Martin Varga; Andreas Tschoner; Richard Partl; Alexander Perathoner; Philipp Gehwolf; Karin S Kapp; Reinhold Függer; Dietmar Öfner; Klaus Emmanuel Journal: World J Surg Oncol Date: 2019-08-19 Impact factor: 2.754