Neoadjuvant treatment is standard care in patients with operable stage IC to IIIB oesophageal adenocarcinomas, well established to increase R0 resection rates and overall survival (OS)1.
Guidelines, varied over time and between institutions, recommend neoadjuvant chemotherapy or chemoradiotherapy (CRT) followed by surgery2,3. To date, no large-scale studies have directly compared neoadjuvant chemotherapy with neoadjuvant CRT.
At Border Medical Oncology (BMO), CROSS protocol CRT is the current standard, with weekly carboplatin and paclitaxel with concurrent radiotherapy over 5 weeks. Perioperative ECF chemotherapy was previously used, comprising three 21-day cycles of epirubicin, cisplatin and flurouracil pre-surgery, then 3 cycles post.
To retrospectively review data of patients treated with ECF and CROSS regimes at BMO. Specifically; patient demographics, treatment completion, resection rates, relapses and survival.
Retrospective data for oesophageal cancer was extracted from the BMO cancer database.
Between June 2002 to January 2020, 74 patients received neoadjuvant ECF (n=56) and CROSS (n=18) for pre-operative oesophageal adenocarcinoma treatment. The ECF group comprised patients diagnosed between June 2002 to August 2017, median age 65.5 years at diagnosis, 85.7% male. The CROSS group comprised patients diagnosed between December 2014 to January 2020 (72% from 2018), with median age 68.5 years at diagnosis, 83.3% male. In the ECF group, all 56 patients completed neoadjuvant treatment and 78.6% underwent resection. In the CROSS group, 94.4% completed neoadjuvant CRT and 83.3% went to surgery. As of August 2020, median progression free survival (PFS) in the ECF group is 22 months (range 4 to 218 months) with mean OS 91.25 months. 45.5% have relapsed after surgery. Survival data for the CROSS group is immature, however median PFS is presently 9.5 months (range 6 to 64 months) with mean OS 22.9 months. 13% have relapsed.
This is an ongoing project; further survival data to be elucidated.