Neoadjuvant chemotherapy versus chemoradiation prior to esophagectomy: Impact on rate of complete pathologic response and survival in esophageal cancer patients.

Authors

A. Lockhart

Albert C. Lockhart

Washington University School of Medicine in St. Louis, St. Louis, MO

Albert C. Lockhart , Pamela Parker Samson , Cliff Grant Robinson , Jeffrey D. Bradley , Varun Puri , Stephen R. Broderick , G Alexander Patterson , Bryan F Meyers , Traves Crabtree

Organizations

Washington University School of Medicine in St. Louis, St. Louis, MO, Washington University in St. Louis, Webster Groves, MO, Washington University in St Louis, St. Louis, MO, Washington University School of Medicine, St. Louis, MO, Washington University in St. Louis, St. Louis, MO, Cardiothoracic Surg LLC, Chesterfield, MO

Research Funding

NIH

Background: At this time, short-and long-term outcomes among locally advanced esophageal cancer patients receiving neoadjuvant chemotherapy versus chemoradiation therapy prior to esophagectomy remain poorly characterized with conflicting findings among various institutions. Methods: Esophageal cancer patients receiving either neoadjuvant chemotherapy or chemoradiation prior to esophagectomy were identified using the National Cancer Data Base (NCDB). Univariate analysis compared patient, tumor, and postoperative outcome characteristics. Logistic regression was performed to identify variables associated with achieving pCR. Kaplan-Meier analysis was performed to compare overall median survival by neoadjuvant therapy type and pCR status. Finally, a Cox proportional hazards model was fitted to identify variables associated with increased mortality hazard. Results: From 2006 – 2012, 916/7,338 (12.5%) of patients received neoadjuvant chemotherapy while 6,422 (87.5%) received neoadjuvant chemoradiation. Neoadjuvant chemoradiation patients were more likely to achieve pCR (17.2% versus 6.4%, p < 0.001) and less likely to have positive margins (5.6% versus 11.5%, p < 0.001) than neoadjuvant chemotherapy patients, with no difference in 30- or 90-day mortality. Achieving pCR was associated with improved overall median survival (59.5 months ± 4.0 versus 30.1 months ± 0.76 for those with persistent disease, p < 0.001). On logistic regression, neoadjuvant chemoradiation therapy was independently associated with achieving pCR (Odds Ratio 2.75, 2.01 – 3.77, p < 0.001). Despite improvement in pCR rate with neoadjuvant chemoradiation, neoadjuvant therapy type was not independently associated with long-term survival (HR 1.12, 95% CI 0.97 – 1.30, p = 0.12). Conclusions: While neoadjuvant chemoradiation is more successful in downstaging esophageal cancer prior to esophagectomy, this therapy was not independently prognostic for improved long-term survival. Other factors affecting long-term survival among pathologic complete responders and among patients with persistent disease should be investigated to clarify this association.

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Abstract Details

Meeting

2016 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal (Noncolorectal) Cancer

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Esophageal or Gastric Cancer

Citation

J Clin Oncol 34, 2016 (suppl; abstr 4054)

DOI

10.1200/JCO.2016.34.15_suppl.4054

Abstract #

4054

Poster Bd #

46

Abstract Disclosures