No Survival Difference with Neoadjuvant Chemoradiotherapy Compared with Chemotherapy in Resectable Esophageal and Gastroesophageal Junction Adenocarcinoma: Results from the National Cancer Data Base

BACKGROUND: Neoadjuvant treatment improves survival in resectable esophageal adenocarcinoma, but the optimal regimen has not been defined. Neoadjuvant chemoradiation (nCRT) is associated with higher pathologic complete response (pCR) relative to chemotherapy (nCTX), but has not been shown to improve survival; however, previous studies have been underpowered to demonstrate a survival difference. The objective of this study was to determine if nCRT is associated with increased survival relative to nCTX in patients with resectable esophageal adenocarcinoma. STUDY DESIGN: The National Cancer Data Base (2006 to 2013) was retrospectively reviewed for patients with esophageal adenocarcinoma who underwent neoadjuvant treatment followed by resection. Data were collected regarding patient, disease, and treatment variables. Outcomes included 3- and 5-year overall survival (OS), pCR rate, and short-term postoperative outcomes. Propensity-adjusted analysis was conducted to account for baseline differences between treatment groups. RESULTS: Six hundred fifty patients received nCTX and 6,336 received nCRT. Patients who underwent nCTX had slightly smaller tumors, and fewer were clinical stage III at baseline. Pathologic complete response was 17.2% with nCTX and 31.6% with nCRT (p < 0.001). Receiving nCRT was associated with fewer nodes examined, fewer nodes involved, fewer T3/4 tumors, and fewer positive margins than nCTX. There was no significant difference in OS between the 2 groups (hazard ratio [HR] 1.08 nCRT vs nCTX, 95% CI 0.95, 1.21, p = 0.228). There was no significant difference in short-term postoperative outcomes by treatment modality. CONCLUSIONS: Neoadjuvant chemoradiation is not associated with improved survival relative to nCTX for resectable esophageal adenocarcinoma. Radiation may potentially be omitted in some patients with this disease. (C) 2016 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.