Abstract
126 Background: The optimal neoadjuvant treatment regimen for esophageal cancer has yet to be defined. Methods: We analyzed a prospective database of esophageal cancer patients treated with cisplatin/5-FU/RT (A) or carboplatin/paclitaxel/RT (B) then esophagectomy. Endpoints were pathologic response (pCR), recurrence, and overall survival. Covariates (age, gender, clinical stage, Charlson comorbidity index (CCI), and ECOG PS) were adjusted via propensity score weighting from logistic regression. Differences in survival curves were compared using weighted Kaplan Meier methods and Wilcoxon tests. Landmark analysis compared differences in outcomes at least six months after surgery. Results: From January 2008 to June 2013, 71 patients received induction RT (50.4 Gy), with 38 and 33 patients in groups A and B, respectively. Patient demographics were similar (Table 1). Operative procedure, R0 resections, and operative complications did not differ (operative mortality 1/71, 1.4%; anastomotic leak rate 10% A vs. 9% B, p=1.0). Median follow-up was 18.2 and 9.1 months for groups A and B, respectively. There was no difference in overall survival (p=0.88) or total number of recurrences (11/38, 29% A vs. 10/33, 30% B). Landmark analysis revealed a difference in recurrence at least 6 months after surgery: time to recurrence was shorter in group B (median time to recurrence 31 mos A vs. 18 mos B, p=0.02). pCR was seen in 13/38 (34%) A and 9/33 (27%) B (p=0.53). In patients with pCR, there was a trend toward more recurrences in group B (2/13, 15% A v 4/9, 44% B, p=0.14). Conclusions: Six months after surgery patients receiving induction carboplatin/paclitaxel/RT had shorter time to recurrence compared to cisplatin/5-FU/RT. In those with pCR a trend towards increased distant recurrences was seen with carboplatin/paclitaxel/RT, which may have less systemic efficacy in esophageal cancer than cisplatin/5-FU/RT. This should be evaluated in larger series. [Table: see text]
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