1. Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials.
- Author
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Oppedijk V, van der Gaast A, van Lanschot JJ, van Hagen P, van Os R, van Rij CM, van der Sangen MJ, Beukema JC, Rütten H, Spruit PH, Reinders JG, Richel DJ, van Berge Henegouwen MI, and Hulshof MC
- Subjects
- Adenocarcinoma secondary, Adult, Aged, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carboplatin administration & dosage, Carcinoma, Squamous Cell secondary, Dose Fractionation, Radiation, Esophageal Neoplasms pathology, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Paclitaxel administration & dosage, Proportional Hazards Models, Risk Factors, Stomach Neoplasms pathology, Time Factors, Treatment Outcome, Adenocarcinoma therapy, Carcinoma, Squamous Cell therapy, Chemotherapy, Adjuvant adverse effects, Esophageal Neoplasms therapy, Esophagectomy adverse effects, Esophagogastric Junction drug effects, Esophagogastric Junction pathology, Esophagogastric Junction radiation effects, Esophagogastric Junction surgery, Gastrectomy adverse effects, Neoadjuvant Therapy adverse effects, Neoplasm Recurrence, Local prevention & control, Stomach Neoplasms therapy
- Abstract
Purpose: To analyze recurrence patterns in patients with cancer of the esophagus or gastroesophageal junction treated with either preoperative chemoradiotherapy (CRT) plus surgery or surgery alone., Patients and Methods: Recurrence pattern was analyzed in patients from the previously published CROSS I and II trials in relation to radiation target volumes. CRT consisted of five weekly courses of paclitaxel and carboplatin combined with a concurrent radiation dose of 41.4 Gy in 1.8-Gy fractions to the tumor and pathologic lymph nodes with margin., Results: Of the 422 patients included from 2001 to 2008, 418 were available for analysis. Histology was mostly adenocarcinoma (75%). Of the 374 patients who underwent resection, 86% were allocated to surgery and 92% to CRT plus surgery. On January 1, 2011, after a minimum follow-up of 24 months (median, 45 months), the overall recurrence rate in the surgery arm was 58% versus 35% in the CRT plus surgery arm. Preoperative CRT reduced locoregional recurrence (LRR) from 34% to 14% (P < .001) and peritoneal carcinomatosis from 14% to 4% (P < .001). There was a small but significant effect on hematogenous dissemination in favor of the CRT group (35% v 29%; P = .025). LRR occurred in 5% within the target volume, in 2% in the margins, and in 6% outside the radiation target volume. In 1%, the exact site in relation to the target volume was unclear. Only 1% had an isolated infield recurrence after CRT plus surgery., Conclusion: Preoperative CRT in patients with esophageal cancer reduced LRR and peritoneal carcinomatosis. Recurrence within the radiation target volume occurred in only 5%, mostly combined with outfield failures.
- Published
- 2014
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