Different regimens of neoadjuvant radio-chemotherapy are concurrently used prior to surgery for resectable, locally advanced esophageal cancer. Comparative data are scarce and to some extent conflicting, regarding toxicity and long-term outcomes when treating different subtypes. This study aimed to assess clinical tolerances and long-term survival of three commonly used combinations of neoadjuvant therapies.
Patients operated from January 2004 to December 2014 who underwent neoadjuvant radio-chemotherapy with Paclitaxel/Carboplatin, or 5FU/Cisplatin, or FOLFOX for adenocarcinoma or squamous cell carcinoma were included. Seven European centers colligated data of 1188 patients. Cases with missing data (n = 147) or death <30 days postoperative (n = 51) were excluded. The primary outcome was the overall survival; secondary outcomes were the completeness and toxicity of neoadjuvant treatment, the disease free survival and the recurrence timing and pattern.
Of the 990 eligible patients, Paclitaxel/Carboplatin was used in 598 patients (60%), 5FU/Cisplatin in 331 (33%) and Folfox in 61 (7%). The groups received a median radiation dose of 41.4 Gy, 45 Gy and 45 Gy (p = 0.65). Adenocarcinoma was the most frequent subtype (69%). No differences were detected in median overall survival (41 months, 34 months and 46 months, p = 0.251). Comparing the overall survival of the three regimens for adenocarcinoma vs squamous cell carcinoma, no difference was observed as well. There were no differences in chemotherapy-related morbidity (13%, 11% and 9%, p = 0.57), chemotherapy completeness (85%, 88% and 90%, p = 0.542) and radiotherapy completeness (98%, 99% and 96%, p = 0.9) between the three groups. Recurrence rates were similar (42%, 46% and 34%, p = 0.169), but median disease-free survival was improved in the 5FU/Cisplatin group (10 months, 18 months and 13 months, p < 0.001).
The overall survival did not differ between different neoadjuvant treatments. Moreover, no advantage of one regimen for specific cancer subtypes was observed. At most, a modest clinical advantage of 5-FU/Cisplatin was observed for disease-free survival.
Clinical trial identification
Research Registry number: 2157.
Legal entity responsible for the study
NeoTEC study group, Lausanne University Hospital, Lausanne, Switzerland.
Has not received any funding.
A.D. Wagner: Research funding: Roche; Consultant or advisory: Lilly, Celgene, Merck, Bristol-Myers Squibb, Pfizer, Servier Shire. M. van Berge Henegouwen: Medtronic, Olympus research grant (other studies). All other authors have declared no conflicts of interest.