Similar Survival With Salvage Surgery After Definitive Chemoradiotherapy vs Neoadjuvant Chemotherapy Followed by Esophagectomy in Esophageal Cancer
In a retrospective European study reported in the Journal of Clinical Oncology, Markar et al found that salvage esophagectomy after definitive chemoradiotherapy was associated with similar survival outcomes vs neoadjuvant chemotherapy followed by planned esophagectomy in treatment of esophageal cancer. Among patients receiving salvage surgery, outcomes were better for those with recurrent vs persistent disease.
Study Details
The study involved data from consecutive adult patients undergoing resection for esophageal cancer in 30 French-speaking European centers from 2000 to 2010, including 308 undergoing salvage surgery after definitive chemoradiotherapy and 540 undergoing neoadjuvant chemotherapy followed by planned esophagectomy. Outcomes were also compared for salvage surgery patients with persistent (n = 234) vs recurrent disease (n = 74). Propensity score matching and multivariable analyses were used to adjust for differences in baseline characteristics.
Outcomes
For the salvage surgery vs neoadjuvant chemotherapy followed by planned esophagectomy groups, in-hospital mortality was similar (8.4% vs 9.3%). Anastomotic leak (17.2% vs 10.7%, P = .007) and surgical-site infection (18.5% vs 12.2%, P = .012) were more frequent in the salvage surgery group. Three-year overall survival was 43.3% vs 40.1% (P = .542), and 3-year disease-free survival was 39.2% vs 32.8%) after matching, with similar recurrence patterns observed in the two groups.
Among patients receiving salvage surgery, there were no differences between those with persistent vs recurrent disease in in-hospital mortality or incidence of major complications. However, 3-year overall survival (40.9% vs 56.2%, P = .046) and disease-free survival (36.6% vs 51.6%, P = .095) were lower in the persistent-disease group.
The investigators concluded: “The results of this large multicenter study from the modern era suggest that [salvage esophagectomy after definitive chemoradiotherapy] can offer acceptable short- and long-term outcomes in selected patients at experienced centers. Persistent cancer after definitive chemoradiotherapy seems to be more biologically aggressive, with poorer survival compared with recurrent cancer.”
Christophe Mariette, MD, PhD, of University Hospital of Lille, is the corresponding author of the Journal of Clinical Oncology article.
For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
