Abstract
Perioperative chemotherapy is the standard of care for patients undergoing curative resection for gastroesophageal adenocarcinoma. However, less than 50% of patients complete postoperative chemotherapy, and the added benefit to preoperative chemotherapy remains unclear. The aim of this study was to compare disease-free and overall survival (DFS and OS) in patients with perioperative chemotherapy to those who received preoperative chemotherapy only. In addition, a current literature overview is included. This multicenter, retrospective case series included 124 patients with gastroesophageal adenocarcinoma undergoing potentially curative resection and receiving pre- or perioperative chemotherapy between 2006 and 2010. Histopathological, demographic, clinical, and survival data were used to identify the impact of perioperative vs. preoperative chemotherapy on DFS and OS. Patients with perioperative chemotherapy had significantly improved DFS and OS (median DFS 28.0 months; 95%CI 0–62.4 vs. 19.0 months; 95%CI 10.5–27.5; p = 0.008 and median OS 35.7 months; 95%CI 0–73.6 vs. 19.2 months; 95%CI 7.8–30.4; p = 0.002). However, in contrast to patients with tumor-free lymph nodes at the time of resection, patients with positive lymph node status did not significantly benefit from additional postoperative chemotherapy in subgroup analysis. Further studies are encouraged to investigate optimal adjuvant treatment strategies for primary chemotherapy-resistant patients.
Highlights
Perioperative chemotherapy is the current standard of care in Europe for localized adenocarcinoma of the stomach, the gastroesophageal junction, and the distal esophagus since results from the MAGIC trial and FNLCC ACCORD07-FFCD 970363 proved significant improvement in overall survival (OS) for patients treated with perioperative chemotherapy compared to surgery alone [1–4]
We investigated the role of postoperative chemotherapy analyzing
We showed that patients who continued perioperative chemotherapy postoperatively had a significantly better disease-free survival (DFS) and OS, compared with patients receiving preoperative chemotherapy alone
Summary
Perioperative chemotherapy is the current standard of care in Europe for localized adenocarcinoma of the stomach, the gastroesophageal junction, and the distal esophagus since results from the MAGIC trial and FNLCC ACCORD07-FFCD 970363 proved significant improvement in overall survival (OS) for patients treated with perioperative chemotherapy compared to surgery alone [1–4]. Perioperative chemotherapy did not increase morbidity from surgery. The German FLOT-4 trial compared the FLOT regimen (5-FU, leucovorin, oxaliplatin, docetaxel) with ECX/ECF (epirubicin, cisplatin, capecitabine/5-FU) and showed a significant improvement in OS for FLOT in 716 patients (median OS 35 months with ECX/ECF vs 50 months with FLOT, p = 0.012), making perioperative chemotherapy with the FLOT regimen the current standard of care in this setting [4]. Previous data suggest that less than 50% of patients in a perioperative treatment concept iations.
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