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The Amount of Neoadjuvant Chemotherapy for Barrett’s Carcinoma Does Not Correlate with Long-Term Survival

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

Several studies have proven an ameliorated prognosis after a neoadjuvant therapy for locally advanced Barrett’s carcinoma in case of response. The necessary amount of neoadjuvant chemotherapy within a multimodal therapy concept with following oesophageal resection has never been evaluated so far.

Methods

The clinical course of 122 patients with Barrett’s carcinoma, who all underwent a neoadjuvant chemotherapy with cisplatin, five fluorouracil and leucovorin and following oesophagectomy, was reviewed. The pretherapeutic clinical and postoperative histopathological staging, histopathological response, clinical course, recurrence rates and long-term survival were retrospectively analysed and compared to the data of 30 patients, who were included in the same multimodal therapy concept, but who had to cease the chemotherapy early because of toxicity.

Results

Postoperative pathological staging showed that the response rate correlates with the N and R status. The responding patients benefit from longer survival. Comparing the two subgroups, we could not find a significant difference in response rate, tumour staging, resection rate, long-term survival or pattern of recurrent disease. However, postoperative morbidity and mortality did not correlate with severe chemotherapy-induced toxicity.

Conclusions

This is the first study on the necessary number of chemotherapy cycles in terms of a neoadjuvant therapy for Barrett’s carcinoma. We could show a similar downstaging effect, a good histopathological response and a comparable ameliorated long-term survival of patients with one compared to patients with three chemotherapy cycles. A biological selection seems to determine the course of the disease already at this early stage.

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Authors and Affiliations

  1. Department of General-, Visceral- and Children’s Surgery, Universitaetsklinikum Duesseldorf, Heinrich Heine Universitaet, Duesseldorf, Germany

    Matthias Schauer, Wolfram Trudo Knoefel, Helmut Friess & Joerg Theisen

  2. Department of Surgery, Technische Universitaet Muenchen, Munich, Germany

    Matthias Schauer, Wolfram Trudo Knoefel, Helmut Friess & Joerg Theisen

  3. Department of General-, Visceral- and Pediatric Surgery, Universitaetsklinikum Duesseldorf, Heinrich Heine Universitaet, Moorenstrasse 5, 40225, Duesseldorf, Germany

    Matthias Schauer

  4. Department of General-, Visceral- and Pediatric Surgery, Heinrich Heine Universitaet, Duesseldorf, Germany

    Matthias Schauer & Wolfram Trudo Knoefel

  5. Technische Universitaet Munich, General Surgery, Munich, Germany

    Helmut Friess & Joerg Theisen

Authors
  1. Matthias Schauer
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  2. Wolfram Trudo Knoefel
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  3. Helmut Friess
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  4. Joerg Theisen
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Corresponding author

Correspondence to Matthias Schauer.

Additional information

The work was funded by the Technische Universitaet Muenchen, Germany. We disclose funding by the NIH, Wellcome Trust, Howard Hughes Medical Institute and others.

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Schauer, M., Knoefel, W.T., Friess, H. et al. The Amount of Neoadjuvant Chemotherapy for Barrett’s Carcinoma Does Not Correlate with Long-Term Survival. J Gastrointest Surg 15, 1750–1755 (2011). https://doi.org/10.1007/s11605-011-1623-6

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  • DOI: https://doi.org/10.1007/s11605-011-1623-6

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