Neoadjuvant CRT Does Not Benefit Patients with cN- Esophageal Adenocarcoma

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Those with clinically staged node-negative (cN–) tumors do not derive a significant overall survival benefit vs surgery alone.
Those with clinically staged node-negative (cN–) tumors do not derive a significant overall survival benefit vs surgery alone.

Patients with clinically staged node-positive (cN+) esophageal adenocarcinoma benefit significantly from neoadjuvant chemoradiation, but those with clinically staged node-negative (cN–) tumors do not derive a significant overall survival benefit vs surgery alone, a new study published online ahead of print in JAMA Surgery has shown.1

Although previous research has demonstrated that neoadjuvant chemoradiation improves outcomes for a broad group of patients with locally advanced and/or node-positive esophageal adenocarcinoma, it is not clear which particular subgroup of patients gains the most overall survival benefit.

For the retrospective study, researchers analyzed data from 1,309 patients with esophageal adenocarcinoma histology and clinical stage T1bN1-N3 or T2-T4aN−/+M0. Of those, 539 had received neoadjuvant chemoradiation followed by surgery and 770 underwent surgery alone, and 47.2% were cN+.

Results showed that at a median follow-up of 73.3 months, the 3-year overall survival was 49% for the neoadjuvant chemoradiation group and 38% for the surgery alone group (P < .001).

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Researchers found that overall survival was significantly better for patients with cN+ disease who received neoadjuvant chemoradiation (HR, 0.52; 95% CI, 0.42-0.66; P < .001), while there was no difference in overall survival between treatment groups for cN– patients (HR, 0.84; 95% CI, 0.65-1.10; P = .22)

“This finding may have significant implications on the use of neoadjuvant chemoradiation in patients with cN− disease,” the authors concluded.

Reference

  1. Gabriel E, Attwood K, Du W, et al. Association between clinically staged node-negative esophageal adenocarcinoma and overall survival benefit from neoadjuvant chemoradiation [published online ahead of print November 11, 2015]. JAMA Surg. doi: 10.1001/jamasurg.2015.4068.

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