Induction FOLFOX and PET-directed chemoradiation for locally advanced esophageal adenocarcinoma Journal Article
| Authors: | Carr, R. A.; Hsu, M.; Harrington, C. A.; Tan, K. S.; Bains, M. S.; Bott, M. J.; Ilson, D. H.; Isbell, J. M.; Janjigian, Y. Y.; Maron, S. B.; Park, B. J.; Rusch, V. W.; Sihag, S.; Wu, A. J.; Jones, D. R.; Ku, G. Y.; Molena, D. |
| Article Title: | Induction FOLFOX and PET-directed chemoradiation for locally advanced esophageal adenocarcinoma |
| Abstract: | Objective: To compare the efficacy and safety of induction FOLFOX followed by PET-directed nCRT, induction CP followed by PET-directed nCRT, and nCRT with CP alone in patients with EAC. Summary of Background Data: nCRT with CP is a standard treatment for locally advanced EAC. The results of cancer and leukemia group B 80803 support the use of induction chemotherapy followed by PET-directed chemo-radiation therapy. Methods: We retrospectively identified all patients with EAC who underwent the treatments above followed by esophagectomy. We assessed incidences of pathologic complete response (pCR), near-pCR (ypN0 with â ‰¥90% response), and surgical complications between treatment groups using Fisher exact test and logistic regression; disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method and evaluated using the log-rank test and extended Cox regression. Results: In total, 451 patients were included: 309 (69%) received induction chemotherapy before nCRT (FOLFOX, n = 70; CP, n = 239); 142 (31%) received nCRT with CP. Rates of pCR (33% vs. 16%, P = 0.004), near-pCR (57% vs. 33%, P < 0.001), and 2-year DFS (68% vs. 50%, P = 0.01) were higher in the induction FOLFOX group than in the induction CP group. Similarly, the rate of near-pCR (57% vs. 42%, P = 0.04) and 2-year DFS (68% vs. 44%, P < 0.001) were significantly higher in the FOLFOX group than in the no-induction group. Conclusions: Induction FOLFOX followed by PET-directed nCRT may result in better histopathologic response rates and DFS than either induction CP plus PET-directed nCRT or nCRT with CP alone. © 2023 Authors. All rights reserved. |
| Keywords: | adult; controlled study; human tissue; treatment response; aged; medical oncologist; retrospective studies; major clinical study; overall survival; mortality; postoperative period; advanced cancer; paclitaxel; disease free survival; neoadjuvant therapy; positron emission tomography; follow up; adenocarcinoma; carboplatin; morbidity; diagnostic imaging; retrospective study; histology; cancer survivor; postoperative complication; length of stay; hospitalization; death; positron-emission tomography; recurrent disease; cell count; esophageal adenocarcinoma; ethnicity; esophagectomy; chemoradiotherapy; induction chemotherapy; race; cumulative incidence; induction; folfox; procedures; endoscopic ultrasonography; in-hospital mortality; minimally invasive esophagectomy; neoadjuvant chemoradiotherapy; maximum standardized uptake value; lymph vessel metastasis; capecitabine plus oxaliplatin; humans; human; male; female; article; people by smoking status; cross regimen; positron emission tomography-directed chemoradiation |
| Journal Title: | Annals of Surgery |
| Volume: | 277 |
| Issue: | 3 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2023-03-01 |
| Start Page: | e538 |
| End Page: | e544 |
| Language: | English |
| DOI: | 10.1097/sla.0000000000005163 |
| PUBMED: | 34387205 |
| PROVIDER: | scopus |
| PMCID: | PMC8840992 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 March 2023 -- Source: Scopus |
