Response-based outcomes in patients with esophageal cancer treated with primarily non-cisplatin and 5-fluorouracil–based trimodality therapy.

Abstract

e14620 Background: Response based outcomes in esophageal cancer patients treated with primarily non cisplatin and 5-fluorouracil based trimodality therapy Methods: Beginning in 2002 at Roswell Park Cancer Institute, alternative neoadjuvant concurrent chemoradiotherapy regimens using combinations of cisplatin, oxaliplatin, irinotecan, or capecitabine were used in the treatment of esophageal cancer patients receiving trimodality therapy. Patients who completed neoadjuvant treatment followed by surgical resection between October 2002 and April 2010 were analyzed. Survival was compared between patients with pathologic complete response (pCR) and those with pathologic non-complete response (pNCR). Follow up was calculated from the date of diagnosis to the date of death or last follow up. Unknown disease status was categorized as a recurrence. Unpaired t-tests were used for statistical comparisons. Results: A total of 115 patients were analyzed, of whom 93% of patients received non cis-5FU based neoadjuvant chemotherapy (40% with cisplatin-irinotecan based therapy, 32% oxaliplatin-capecitabine based regimens, and 15% oxaliplatin-5 FU based chemotherapy). pCR was noted in 19.1% of patients. There was no difference in gender, histology, proportion of patients receiving non cis-5FU based chemotherapy, mean radiotherapy dose delivered, chemoradiotherapy completion time, or total follow up time between patients with pCR and pNCR. With an overall median follow-up time of 28 months, survival analysis demonstrated that pCR patients had decreased disease recurrence (23% vs. 49%, p=0.0232), improved disease specific mortality (9% vs. 46%, p=0.001), and increased overall survival (77% vs. 44%, p=0.0048). Conclusions: In esophageal carcinoma patients treated with primarily non cis-5FU based neoadjuvant concurrent chemoradiotherapy followed by surgical resection, pathologic complete response appears to predict a significantly decreased risk of disease recurrence and improved survival.