Gregory Tiesi1, Wungki Park2, Meredith Gunder3, Gustavo Rubio3, Michael Berger3, Bach Ardalan2, Alan Livingstone3, Dido Franceschi3. 1. Division of Surgical Oncology, Department of General Surgery, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami Hospital, Miami, Florida. Electronic address: gregorytiesiMD@gmail.com. 2. Division of Hematology-Oncology, Department of Medicine, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami Hospital, Miami, Florida. 3. Division of Surgical Oncology, Department of General Surgery, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami Hospital, Miami, Florida.
Abstract
BACKGROUND: Neoadjuvant treatment is standard for locally advanced esophageal cancer. However, whether the addition of radiation to neoadjuvant regimen improves survival remains unclear. The aim of this study was to compare survival in locally advanced esophageal cancer treated with neoadjuvant chemotherapy versus chemoradiation. MATERIALS AND METHODS: A prospectively maintained database of esophagectomies (1999-2012) was analyzed. We identified 297 patients with locally advanced esophageal cancer that underwent either neoadjuvant chemotherapy (n = 231) or chemoradiation (n = 66) followed by esophagectomy. Pretreatment and pathologic staging were compared to assess response. Overall survival was recorded. RESULTS: Most patients in the chemotherapy and chemoradiation groups had pretreatment stage III disease (66.7% versus 65.2%; P = 0.44). Median follow-up was 79.3 and 64.9 mo for chemotherapy and chemoradiation cohorts, respectively. Complete response rate was higher in chemoradiation than chemotherapy groups (30.3% versus 13.8%; P < 0.001). Overall survival was similar between complete responders in both groups (median not reached versus 121.1 mo; chemotherapy versus chemoradiation). However, partial responders in the chemotherapy cohort had improved median survival (147.2 mo) versus those in the chemoradiation cohort (83.7 mo, P < 0.03). Within the chemotherapy-only group, partial responders had improved survival compared with nonresponders (P = 0.041); however, there was no difference in survival between partial and complete responders (P = 0.36). CONCLUSIONS: In patients undergoing esophagectomy for locally advanced esophageal cancer, neoadjuvant chemotherapy was associated with an equivalent overall survival, when compared with neoadjuvant chemoradiotherapy. Adding neoadjuvant radiation may enhance complete response rates but does not appear to be associated with improved survival.
BACKGROUND: Neoadjuvant treatment is standard for locally advanced esophageal cancer. However, whether the addition of radiation to neoadjuvant regimen improves survival remains unclear. The aim of this study was to compare survival in locally advanced esophageal cancer treated with neoadjuvant chemotherapy versus chemoradiation. MATERIALS AND METHODS: A prospectively maintained database of esophagectomies (1999-2012) was analyzed. We identified 297 patients with locally advanced esophageal cancer that underwent either neoadjuvant chemotherapy (n = 231) or chemoradiation (n = 66) followed by esophagectomy. Pretreatment and pathologic staging were compared to assess response. Overall survival was recorded. RESULTS: Most patients in the chemotherapy and chemoradiation groups had pretreatment stage III disease (66.7% versus 65.2%; P = 0.44). Median follow-up was 79.3 and 64.9 mo for chemotherapy and chemoradiation cohorts, respectively. Complete response rate was higher in chemoradiation than chemotherapy groups (30.3% versus 13.8%; P < 0.001). Overall survival was similar between complete responders in both groups (median not reached versus 121.1 mo; chemotherapy versus chemoradiation). However, partial responders in the chemotherapy cohort had improved median survival (147.2 mo) versus those in the chemoradiation cohort (83.7 mo, P < 0.03). Within the chemotherapy-only group, partial responders had improved survival compared with nonresponders (P = 0.041); however, there was no difference in survival between partial and complete responders (P = 0.36). CONCLUSIONS: In patients undergoing esophagectomy for locally advanced esophageal cancer, neoadjuvant chemotherapy was associated with an equivalent overall survival, when compared with neoadjuvant chemoradiotherapy. Adding neoadjuvant radiation may enhance complete response rates but does not appear to be associated with improved survival.
Authors: Tarek Sawas; Sarah Killcoyne; Prasad G Iyer; Kenneth K Wang; Thomas C Smyrk; John B Kisiel; Yi Qin; David A Ahlquist; Anil K Rustgi; Rui J Costa; Moritz Gerstung; Rebecca C Fitzgerald; David A Katzka Journal: Gastroenterology Date: 2018-08-27 Impact factor: 22.682
Authors: Sonja Kappel-Latif; Johannes Zacherl; Michael Hejna; Maria Westerhoff; Dietmar Tamandl; Ahmed Ba-Ssalamah; Martina Mittlböck; Brigitte Wolf; Friedrich Wrba; Irene Kührer; Ursula Pluschnig; Sebastian F Schoppmann; Reinhold Függer; Ronald Zwrtek; Karl Glaser; Josef Karner; Friedrich Längle; Etienne Wenzl; Rudolf Roka; Dietmar Öfner; Jörg Tschmelitsch; Michael Hold; Felix Keil; Michael Gnant; Daniela Kandioler Journal: Eur Surg Date: 2018-06-11 Impact factor: 0.953