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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2023

Open Access 21-05-2023 | Esophagus Resection | Thoracic Oncology

Long-Term Postsurgical Outcomes of Neoadjuvant Chemoradiation (CROSS) Versus Chemotherapy (FLOT) for Multimodal Treatment of Adenocarcinoma of the Esophagus and the Esophagogastric Junction

Authors: Florian Gebauer, MD, Patrick S. Plum, MD, Alexander Damanakis, MD, Seung-Hun Chon, MD, Felix Popp, MD, Thomas Zander, MD, Alexander Quaas, MD, Hans Fuchs, MD, Thomas Schmidt, MD, Wolfgang Schröder, MD, Christiane J. Bruns, MD

Published in: Annals of Surgical Oncology | Issue 12/2023

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Abstract

Background

The question of the ideal neoadjuvant therapy for locally advanced esophagogastric adenocarcinoma has not been answered to date. Multimodal treatment has become a standard treatment for these adenocarcinomas. Currently, perioperative chemotherapy (FLOT) or neoadjuvant chemoradiation (CROSS) is recommended.

Methods

A monocentric retrospective analysis compared long-term survival after CROSS versus FLOT. The study enrolled patients with adenocarcinoma of the esophagus (EAC) or the esophagogastric junction type I or II undergoing oncologic Ivor–Lewis esophagectomy between January 2012 and December 2019. The primary objective was to determine the long-term outcome in terms of overall survival. The secondary objectives were to determine differences regarding the histopathologic categories after neoadjuvant treatment and the histomorphologic regression.

Results

The findings showed no survival advantage for one or the other treatment in this highly standardized cohort. All the patients underwent open (CROSS: 9.4% vs. FLOT: 22%), hybrid (CROSS: 82% vs. FLOT: 72%), or minimally invasive (CROSS: 8.9% vs. FLOT: 5.6%) thoracoabdominal esophagectomy. The median post-surgical follow-up period was 57.6 months (95% confidence interval [CI] 23.2–109.7 months), and the median survival was longer for the CROSS patients (54 months) than for the FLOT patients (37.2 months) (p = 0.053). The overall 5-years survival was 47% for the entire cohort (48% for the CROSS and 43% for the FLOT patients). The CROSS patients showed a better pathologic response and fewer advanced tumor stages.

Conclusion

The improved pathologic response after CROSS cannot be translated into longer overall survival. To date, the choice of which neoadjuvant treatment to use can be made only on the basis of clinical parameters and the patient’s performance status.
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Metadata
Title
Long-Term Postsurgical Outcomes of Neoadjuvant Chemoradiation (CROSS) Versus Chemotherapy (FLOT) for Multimodal Treatment of Adenocarcinoma of the Esophagus and the Esophagogastric Junction
Authors
Florian Gebauer, MD
Patrick S. Plum, MD
Alexander Damanakis, MD
Seung-Hun Chon, MD
Felix Popp, MD
Thomas Zander, MD
Alexander Quaas, MD
Hans Fuchs, MD
Thomas Schmidt, MD
Wolfgang Schröder, MD
Christiane J. Bruns, MD
Publication date
21-05-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-13643-9

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