Postoperative and Pathological Outcomes of CROSS and FLOT as Neoadjuvant Therapy for Esophageal and Junctional Adenocarcinoma Academic Article

journal

  • Annals of Surgery

abstract

  • Objective: This study aimed to compare the postoperative and pathological outcomes between carboplatin, paclitaxel, radiotherapy (CROSS) and 5-FU, leucovorine, oxaliplatin and docetaxel (FLOT) in esophageal adenocarcinoma (EAC) patients from an international, multicenter cohort. Summary of Background Data: Ongoing debate exists around optimum approach to locally advanced EAC, with proponents for perioperative chemotherapy, such as FLOT, or multimodal therapy, in particular the CROSS regimen. Methods: Patients undergoing CROSS (n = 350) and FLOT (n = 368), followed by curative esophagectomy for EAC were identified from the Oesophagogastric Anastomosis Audit. Results: The 90-day mortality was higher after CROSS than FLOT (5percent-flag-change vs 1percent-flag-change, P = 0.005), even on adjusted analyses [odds ratio (OR): 3.97, confidence interval (CI)95percent-flag-change: 1.34-13.67]. Postoperative mortality in CROSS were related to higher pulmonary (74percent-flag-change vs 60percent-flag-change) and cardiac complications (42percent-flag-change vs 20percent-flag-change) compared to FLOT. CROSS was associated with higher pathologic complete response (pCR) rates (18percent-flag-change vs 10percent-flag-change, P = 0.004) and margin-negative resections (93percent-flag-change vs 76percent-flag-change, P ylt; 0.001) compared with FLOT. On adjusted analyses, CROSS was associated with higher pCR rates (OR: 2.05, CI95percent-flag-change: 1.26-3.34) and margin-negative resections (OR: 4.55, CI95percent-flag-change: 2.70-7.69) compared to FLOT. Conclusions: This study provides real-world data CROSS was associated with higher 90-day mortality than FLOT, related to cardio-pulmonary complications with CROSS. These warrant a further review into causes and mechanisms in selected patients, and at minimum suggest the need for strict radiation therapy quality assurance. Research into impact of higher pCR rates and R0 resections with CROSS compared to FLOT on long-term survival is needed.

authors

publication date

  • 2023-5-1

edition

  • 277

keywords

  • Adenocarcinoma
  • Carboplatin
  • Cohort Studies
  • Confidence Intervals
  • Docetaxel
  • Drug Therapy
  • Esophagectomy
  • Fluorouracil
  • Lung
  • Margins of Excision
  • Mortality
  • Neoadjuvant Therapy
  • Odds Ratio
  • Oxaliplatin
  • Paclitaxel
  • Radiotherapy
  • Survival
  • Therapeutics

International Standard Serial Number (ISSN)

  • 0003-4932

start page

  • E1026

end page

  • E1034