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Intensified Neoadjuvant Chemoradiotherapy for Patients with Potentially Resectable Esophageal Cancer: A Retrospective Cohort Study

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

Abstract

Background

Neoadjuvant treatment consisting of five cycles of carboplatin and paclitaxel with concurrent radiotherapy (41.4 Gy), followed by esophagectomy, is the standard treatment for resectable esophageal cancer in The Netherlands. It remains unclear whether intensification of neoadjuvant therapy leads to better outcomes. This study analyzed the outcomes of intensified chemoradiotherapy.

Methods

We included patients who were deemed eligible for esophagectomy between January 2008 and December 2014. Neoadjuvant therapy consisted of six cycles of carboplatin (area under the curve = 2 mg/mL/min) and paclitaxel (50 mg/m2 of body surface area) and concurrent radiotherapy (50.4 Gy administered in 28 fractions of 1.8 Gy each, 5 days per week), followed by esophagectomy.

Results

Of the 176 patients included in this study, 73% underwent a resection. At a median follow-up of 29.3 months for the total cohort, median disease-free survival (DFS) was 22.5 months. DFS at 3 and 5 years was 42% and 36%, respectively, while the overall survival (OS) rates were 47% and 38%, respectively. In addition, the 5-year DFS and OS rates of our resection group were 44% and 48%, respectively. In 102 patients (58%), grade 3 or higher adverse events were observed, mainly hematological. The postoperative mortality rate within 30 days was 4%, and pathological complete response was achieved in 35% of patients.

Conclusions

Intensification of neoadjuvant chemoradiotherapy for patients with potentially resectable esophageal cancer is well tolerated, yielding high pathological complete response rates, but adverse events occurred frequently, and survival compared with conventional neoadjuvant chemoradiotherapy seems similar. Therefore, intensification of neoadjuvant chemoradiotherapy should not be routinely used.

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Authors and Affiliations

  1. Department of Medical Oncology, Isala Oncology Center, Dr van Heesweg 2, 8025 AB, Zwolle, The Netherlands

    Jorianne Boers MD, Jacques C. de Graaf MD, PhD & Jan Willem B. de Groot MD, PhD

  2. Department of Surgery, Isala Oncology Center, Dr van Heesweg 2, 8025 AB, Zwolle, The Netherlands

    Annalie Joldersma MSc, Annette D. van Dalsen MD & Engelbertus G. J. M. Pierik MD, PhD

  3. Department of Radiation Oncology, Isala Oncology Center, Dr van Heesweg 2, 8025 AB, Zwolle, The Netherlands

    Erwin M. Wiegman MD, PhD & Paul R. Timmer MD, PhD

  4. Department of Gastroenterology and Hepatology, Isala Oncology Center, Dr van Heesweg 2, 8025 AB, Zwolle, The Netherlands

    B. Ed Schenk MD, PhD

Authors
  1. Jorianne Boers MD
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  2. Annalie Joldersma MSc
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  3. Annette D. van Dalsen MD
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  4. Erwin M. Wiegman MD, PhD
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  5. B. Ed Schenk MD, PhD
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  6. Jacques C. de Graaf MD, PhD
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  7. Engelbertus G. J. M. Pierik MD, PhD
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  8. Paul R. Timmer MD, PhD
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  9. Jan Willem B. de Groot MD, PhD
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Corresponding author

Correspondence to Jan Willem B. de Groot MD, PhD.

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Disclosures

Jorianne Boers, Annalie Joldersma, Annette D. van Dalsen, Erwin M. Wiegman, B. Ed Schenk, Jacques C. de Graaf, Engelbertus G.J.M. Pierik, Paul R. Timmer, and Jan Willem B. de Groot have no discloses to declare.

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Boers, J., Joldersma, A., van Dalsen, A.D. et al. Intensified Neoadjuvant Chemoradiotherapy for Patients with Potentially Resectable Esophageal Cancer: A Retrospective Cohort Study. Ann Surg Oncol 27, 1520–1528 (2020). https://doi.org/10.1245/s10434-019-08114-z

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  • DOI: https://doi.org/10.1245/s10434-019-08114-z

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