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Induction Chemotherapy Plus Neoadjuvant Chemoradiation for Esophageal and Gastroesophageal Junction Adenocarcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemotherapy with concurrent radiotherapy (nCRT) is an accepted treatment regimen for patients with potentially curable esophageal and gastroesophageal junction (GEJ) adenocarcinoma. The purpose of this study is to evaluate whether induction chemotherapy (IC) before nCRT is associated with improved pathologic complete response (pCR) and overall survival (OS) when compared with patients who received nCRT alone for esophageal and GEJ adenocarcinoma.

Methods

Using the National Cancer Database (NCDB), patients who received nCRT and curative-intent esophagectomy for esophageal or GEJ adenocarcinoma from 2006 to 2015 were included. Chemotherapy and radiation therapy start dates were used to define cohorts who received IC before nCRT (IC + nCRT) versus those who only received concurrent nCRT before surgery. Propensity weighting was conducted to balance patient, disease, and facility covariates between groups.

Results

12,460 patients met inclusion criteria, of whom 11,880 (95%) received nCRT and 580 (5%) received IC + nCRT. Following propensity weighting, OS was significantly improved among patients who received IC + nCRT versus nCRT (HR 0.82; 95% CI 0.74–0.92; p < 0.001) with median OS for the IC + nCRT cohort of 3.38 years versus 2.45 years for nCRT. For patients diagnosed from 2013 to 2015, IC + nCRT was also associated with higher odds of pCR compared with nCRT (OR 1.59; 95% CI 1.14–2.21; p = 0.007).

Conclusion

IC + nCRT was associated with a significant OS benefit as well as higher pCR rate in the more modern patient cohort. These results merit consideration of a sufficiently powered prospective multiinstitutional trial to further evaluate these observed differences.

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Acknowledgment

F.H. is supported by the Dr. Harold J. and Claire Wanebo Endowed Research Fellowship at University of Colorado. R.J.T is supported by NIH/NCATS Colorado CTSA grant no. TL1 TR002533. S.W. is supported by the University of Colorado Department of Medicine Outstanding Early Scholars Program

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Felix Ho MD, MPH, Robert J. Torphy MD, PhD, Chloe Friedman MPH, Ana L. Gleisner MD, PhD & Martin D. McCarter MD

  2. Department of Medicine, Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Stephen Leong MD & Sunnie Kim MD

  3. Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Sachin Wani MD

  4. Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Tracey Schefter MD

  5. Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Christopher D. Scott MD, John D. Mitchell MD, Michael J. Weyant MD & Robert A. Meguid MD, MPH

  6. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Karyn A. Goodman MD

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  1. Felix Ho MD, MPH
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  2. Robert J. Torphy MD, PhD
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Correspondence to Martin D. McCarter MD.

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Disclosure

S.W.: consultant for Boston Scientific, Medtronic, Interpace and Cernostics. M.W.: Intuitive Surgical-Educational Consultant; Medtronic-educational consultant. Other authors declare no conflicts of interest.

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Ho, F., Torphy, R.J., Friedman, C. et al. Induction Chemotherapy Plus Neoadjuvant Chemoradiation for Esophageal and Gastroesophageal Junction Adenocarcinoma. Ann Surg Oncol 28, 7208–7218 (2021). https://doi.org/10.1245/s10434-021-09999-5

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  • DOI: https://doi.org/10.1245/s10434-021-09999-5

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