SIMILAR SURVIVAL WITH NEOADJUVANT CHEMOTHERAPY AND CHEMORADIOTHERAPY FOR OESOPHAGEAL CANCER

NEW YORK (Reuters Health) - Survival does not differ for patients with resectable esophageal cancer who are treated with neoadjuvant chemoradiotherapy and chemotherapy, respectively, according to new findings.

Current National Comprehensive Cancer Network (NCCN) guidelines recommend preoperative chemoradiation (nCRT) for the treatment of esophageal adenocarcinoma, with neoadjuvant chemotherapy (nCTX) without radiation listed as an acceptable alternative.

No randomized study, however, has found nCRT to confer a survival advantage over nCTX in this population, researchers note in a report online September 15 in the Journal of the American College of Surgeons.

Dr. Steven N. Hochwald and colleagues from Roswell Park Cancer Institute in Buffalo, New York, used data on almost 7,000 patients in the National Cancer Data Base to investigate whether CRT administered before resection for adenocarcinoma of the middle and distal esophagus is associated with better survival than nCTX.

After a median follow-up of 51.5 months, median overall survival did not differ significantly after nCRT (35.2 months) and after nCTX (37.5 months, p=0.445), the team found.

Estimated three- and five-year overall survival was 49% and 37%, respectively, after nCRT, versus 52% and 37%, respectively, after nCTX. Propensity-adjusted analysis confirmed the lack of significant difference in overall survival between nCRT and nCTX.

Results were similar in a subgroup analysis of patients who achieved pathologic complete response (pCR) with nCRT or nCTX.

"Neoadjuvant CRT is associated with lower margin positivity, fewer lymph node metastases, and higher pCR than chemotherapy alone for adenocarcinoma of the middle and distal esophagus," the researchers conclude.

"Despite this, a survival benefit could not be demonstrated with CRT compared with chemotherapy alone upon analysis of a large cohort of patients from the NCDB. Radiation can potentially be safely omitted in some patients with esophageal adenocarcinoma without compromising survival," they add.

"Further research is necessary to identify the optimal chemotherapy regimen associated with the highest survival in this patient population," the team concludes. "As multimodal agents and targeted therapies improve, perhaps radiotherapy will only be utilized in selected patients."

Dr. Hochwald did not respond to a request for comments.