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Open Access 01-08-2017 | Gastrointestinal Oncology

Preoperative Chemoradiotherapy Versus Perioperative Chemotherapy for Patients With Resectable Esophageal or Gastroesophageal Junction Adenocarcinoma

Authors: M. C. J. Anderegg, MD, P. C. van der Sluis, MD, Msc, J. P. Ruurda, MD, PhD, S. S. Gisbertz, MD, PhD, M. C. C. M. Hulshof, MD, PhD, M. van Vulpen, MD, PhD, N. Haj Mohammed, MD, PhD, H. W. M. van Laarhoven, MD, PhD, M. J. Wiezer, MD, PhD, M. Los, MD, PhD, M. I. van Berge Henegouwen, MD, PhD, R. van Hillegersberg, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2017

Abstract

Background

This study compares neoadjuvant chemoradiotherapy (nCRT) with perioperative chemotherapy (pCT) for patients with resectable esophageal or gastroesophageal junction (GEJ) adenocarcinoma in terms of toxicity, postoperative complications, pathologic response, and survival.

Methods

This study retrospectively analyzed and compared 313 patients with resectable esophageal or GEJ adenocarcinoma treated with either nCRT (carboplatin/paclitaxel 41.4 Gy, n = 176) or pCT (epirubicin, cisplatin and capecitabine, n = 137).

Results

The baseline and tumor characteristics were similar in both groups. The ability to deliver all planned preoperative cycles was greater in the nCRT group (92.0 vs. 76.6%). Whereas nCRT was associated with a higher rate of grades 3 and 4 esophagitis, pCT was associated with a higher rate of grades 3 and 4 thromboembolic events, febrile neutropenia, nausea, vomiting, diarrhea, hand–foot syndrome, mucositis, cardiac complications, and electrolyte imbalances. Two patients in the pCT group died during neoadjuvant treatment due to febrile neutropenia. More postoperative cardiac complications occurred in the nCRT group. All other postoperative complications and the in-hospital mortality rate (nCRT, 4.7%; pCT, 2.3%) were comparable. The pathologic complete response (pCR) rate was 15.1% after nCRT and 6.9% after pCT. Radicality of surgery was comparable (R0: 93.0 vs. 91.6%). The median overall survival was 35 months after nCRT versus 36 months after pCT.

Conclusion

For patients with esophageal or GEJ adenocarcinoma, chemoradiotherapy with paclitaxel, carboplatin and concurrent radiotherapy, and perioperative chemotherapy with epirubicin, cisplatin, and capecitabin lead to equal oncologic outcomes in terms of radical resection rates, lymphadenectomy, patterns of recurrent disease, and (disease-free) survival. However, neoadjuvant chemoradiotherapy is associated with a considerably lower level of severe adverse events and should therefore be the preferred protocol until a well-powered randomized controlled trial provides different insights.

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Title: Preoperative Chemoradiotherapy Versus Perioperative Chemotherapy for Patients With Resectable Esophageal or Gastroesophageal Junction Adenocarcinoma
Authors: M. C. J. Anderegg, MD
P. C. van der Sluis, MD, Msc
J. P. Ruurda, MD, PhD
S. S. Gisbertz, MD, PhD
M. C. C. M. Hulshof, MD, PhD
M. van Vulpen, MD, PhD
N. Haj Mohammed, MD, PhD
H. W. M. van Laarhoven, MD, PhD
M. J. Wiezer, MD, PhD
M. Los, MD, PhD
M. I. van Berge Henegouwen, MD, PhD
R. van Hillegersberg, MD, PhD
Publication date: 01-08-2017
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 8/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-5827-1

At a glance: The STEP trials

Springer Medicine

Preoperative Chemoradiotherapy Versus Perioperative Chemotherapy for Patients With Resectable Esophageal or Gastroesophageal Junction Adenocarcinoma

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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