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Different Recurrence Pattern After Neoadjuvant Chemoradiotherapy Compared to Surgery Alone in Esophageal Cancer Patients

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

Abstract

Purpose

To evaluate the rate and pattern of recurrences after neoadjuvant chemoradiotherapy (CRT) in esophageal cancer patients.

Methods

We described survival and differences in recurrences from a single center between neoadjuvant CRT (carboplatin/paclitaxel and 41.4 Gy) and surgery alone for the period 2000–2011. To reduce bias, we performed a propensity score matched analysis.

Results

A total of 204 patients were analyzed, 75 treated with neoadjuvant CRT and 129 with surgery alone. The pathologic response to neoadjuvant CRT was 69 % with a complete response rate of 25 %. After matching, baseline characteristics between the groups (both n = 75) were equally distributed. The 3- and 5-year disease-free survival was 53 and 42 % in the neoadjuvant CRT group compared with 24 and 18 % in the surgery-alone group (P = 0.011). After 3 and 5 years’ CRT, patients had an estimated locoregional recurrence-free survival of 83 and 73 % compared with 52 and 49 % in the surgery-alone group (P = 0.015). The distant recurrence-free survival was comparable in both groups. Locoregional recurrences were located less in the paraesophageal lymph nodes in the CRT group than in the surgery-alone group, 9 versus 21 %, respectively (P = 0.041). With respect to differences in distant recurrences, we observed more skeletal recurrences in the surgery-alone group compared to CRT, 12 versus 1 % (P = 0.009).

Conclusions

The neoadjuvant CRT regimen we used offers a significant improvement in outcome, with a different recurrence pattern compared with surgery alone. This effect is probably due to both the pathologic complete response and eradication of micrometastases in CRT group.

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Acknowledgment

Supported by GUIDE Postgraduate School of Medicine, University of Groningen. The authors thank Peter Nagle, MSc, for editorial services.

Disclosure

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Authors and Affiliations

  1. Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Justin K. Smit MD, Sahin Güler Bsc & John Th. M. Plukker MD, PhD

  2. Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Jannet C. Beukema MD & Véronique E. Mul MD

  3. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Johannes G. M. Burgerhof MSc

  4. Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Geke A. P. Hospers MD, PhD

Authors
  1. Justin K. Smit MD
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  2. Sahin Güler Bsc
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  3. Jannet C. Beukema MD
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  4. Véronique E. Mul MD
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  7. John Th. M. Plukker MD, PhD
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Corresponding author

Correspondence to John Th. M. Plukker MD, PhD.

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Smit, J.K., Güler, S., Beukema, J.C. et al. Different Recurrence Pattern After Neoadjuvant Chemoradiotherapy Compared to Surgery Alone in Esophageal Cancer Patients. Ann Surg Oncol 20, 4008–4015 (2013). https://doi.org/10.1245/s10434-013-3102-7

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  • DOI: https://doi.org/10.1245/s10434-013-3102-7

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