Multimodal Treatment of Locally Advanced Esophageal Adenocarcinoma: Which Regimen Should We Choose? Outcome Analysis of Perioperative Chemotherapy Versus Neoadjuvant Chemoradiation in 105 Patients

BackgroundThe study was done to compare treatment and long-term outcomes of neoadjuvant chemoradiation (neoCRT) and perioperative chemotherapy (periCTX) in patients with surgically treated esophageal adenocarcinoma. MethodsAn analysis of 105 patients with esophageal adenocarcinoma undergoing neoCRT (n=58) or periCTX (n=47) and esophagectomy between 2000 and 2012 was carried out. ResultsThe overall median survival was 5.97 years. Postoperative morbidity and in-hospital mortality occurred in 74%/7% of the patients the neoCRT group and in 53%/0% of the patients in the periCTX group (P=0.03/P=0.08). Total or subtotal histological tumor response after neoadjuvant treatment and esophagectomy was found in 59% after neoCRT and 30% after periCTX (P<0.01). Three- and five-year survival rates were 52%/45% for neoCRT and 68%/63% for periCTX (P=0.05). PeriCTX was identified as an independent predictor of survival (RR2.6; 95% CI 1.3-5.1; P<0.01). ConclusionA higher rate of histologic response to neoCRT compared to histologic response following the preoperative cycles of periCTX does not translate to a benefit in overall survival. PeriCTX offers a decreased incidence of treatment-related morbidity and mortality and at least equal results in terms of survival compared to neoCRT in patients with locally advanced esophageal adenocarcinoma. J. Surg. Oncol. 2014 109:287-293. (c) 2013 Wiley Periodicals, Inc.