Adjuvant Chemotherapy vs Postoperative Observation Following Preoperative Chemoradiotherapy and Resection in Gastroesophageal Cancer

Mokdad, Ali H.; Yopp, Adam C.; Polanco, Patricio M.; Mansour, John C.; Reznik, Scott I.; Heitjan, Daniel F.; Choti, Michael A.; Minter, Rebecca R.; Wang, Sam C.; Porembka, Matthew R.

doi:10.1001/jamaoncol.2017.2805

Cited by 71 publications

(69 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is relevant because the value of adjuvant chemotherapy after neoadjuvant CRT for GE junction cancers cannot be discounted. As reported by Mokdad et al, the addition of adjuvant chemotherapy conferred a substantial overall survival benefit (median overall survival of 40 months vs 34 months: hazard ratio, 0.79; stratified log‐rank P < .001) . These 3 studies analyzed only patients with cancers of the lower esophagus and GE junction, whereas approximately 31% of the patients in our study had gastric adenocarcinoma primary tumors .…”

supporting

confidence: 59%

Examining the use of pre‐operative radiation therapy in addition to perioperative chemotherapy: National Cancer Data Base vs. Surveillance, Epidemiology, and End Results

Tian

Jiang

Patel

2020

Cancer

View full text Add to dashboard Cite

supporting

confidence: 59%

Examining the use of pre‐operative radiation therapy in addition to perioperative chemotherapy: National Cancer Data Base vs. Surveillance, Epidemiology, and End Results

Tian

Jiang

Patel

2020

Cancer

View full text Add to dashboard Cite

“…Several studies have described the association between RT dose to the heart and either any‐cause mortality or cardiac events . The use of preoperative RT may have compromised patients' capacity to receive the planned amount of adjuvant chemotherapy, the use of which has been linked to a significant survival advantage …”

Section: Discussionmentioning

confidence: 99%

“…Others have found no survival gain with the addition of preoperative RT to neoadjuvant chemotherapy and surgery (HR, 1.08; P = .23) . Last, Mokdad et al reported on >10,000 patients in the NCDB with locally advanced esophageal and GEJ adenocarcinomas who were treated with preoperative chemoradiation, and reported a significant benefit to the addition of adjuvant chemotherapy (HR, 0.79; P < .001) . It is interesting to note that no historical randomized study included adjuvant therapy if preoperative RT was given.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] The use of preoperative RT may have compromised patients' capacity to receive the planned amount of adjuvant chemotherapy, the use of which has been linked to a significant survival advantage. 15 The advantages of preoperative therapy have been well described. The use of neoadjuvant chemotherapy has been advocated to downstage bulky locally invasive tumors and improve resectability and the marginnegative surgical resection rate.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Survival outcomes in patients with gastric and gastroesophageal junction adenocarcinomas treated with perioperative chemotherapy with or without preoperative radiotherapy

Tian

Jiang

Madden

et al. 2019

Cancer

View full text Add to dashboard Cite

Background Perioperative chemotherapy (POC) is one standard approach for the treatment of resectable cancers of the stomach and gastroesophageal junction (GEJ), whereas there has been growing interest in preoperative therapies. The objective of the current study was to compare survival between patients treated with preoperative chemoradiotherapy and adjuvant chemotherapy (PCRT) with those receiving POC using a large database. Methods The National Cancer Data Base was queried for patients diagnosed between 2004 and 2013 with American Joint Committee on Cancer clinical group stage IB to stage IIIC (excluding T2N0 disease) adenocarcinoma of the stomach or GEJ. Patients treated with definitive surgery and POC with or without preoperative radiotherapy of 41 to 54 Gy were included. Overall survival (OS) was defined from the date of definitive surgery and estimated using the Kaplan‐Meier method. A total of 14 patient and treatment variables were used for propensity score matching (PSM). Results A total of 1048 patients were analyzed: 53.2% received POC and 46.8% received PCRT. The primary tumor site was the GEJ in 69.1% of patients and stomach in 30.9% of patients. The median age of the patients was 60 years, and the median follow‐up was 25.8 months. The use of PCRT was associated with a greater pathologic complete response rate of 13.1% versus 8.2% (P = .01). POC was associated with a decreased risk of death in unmatched groups (hazard ratio [HR], 0.83; P = .043). Using PSM cohorts, POC decreased the risk of death with a median OS of 45.1 months versus 31.4 months (HR, 0.70; P = .016). The 2‐year OS rate was 72.9% versus 62.5% and the 5‐year OS rate was 40.7% versus 33.1% for POC versus PCRT, respectively. Survival favored POC in PSM gastric (HR, 0.41; P = .07) and GEJ (HR, 0.77; P = .08) patient subgroups. Conclusions The addition of preoperative radiotherapy to POC appears to be associated with an increased risk of death in patients with resectable gastric and GEJ cancers.

show abstract

“…Our meta-analysis included seven eligible studies that had more than 10720 patients. [6][7][8][9][10][11][12] A ow chart of the procedures followed in literature retrieval and selection is shown in Fig. 1.…”

Section: Trial Flow and Characteristicsmentioning

confidence: 99%

Is postoperative chemotherapy necessary for resected esophageal carcinoma after neoadjuvant chemoradiotherapy? A systematic review and meta-analysis

Liu

Gao

Yang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Both neoadjuvant chemoradiotherapy (NCRT) and postoperative chemotherapy (PT) are crucial treatments for esophageal carcinoma (EC). However, it is not clear whether PT is required for EC treatment after NCRT. This systematic review and meta-analysis aimed at clarifying the necessity of PT for resected EC after NCRT.Methods We searched PubMed, Embase, and The Cochrane Library databases for relevant studies published up to March 2020, that have compared PT and non-PT for resected EC after NCRT (NCRT + PT vs. NCRT). The primary outcome of this study was overall survival (OS). Hazard risk ratio (HR) and 95% confidence interval (CI) were calculated. Subgroup and sensitivity analyses were employed to explore heterogeneity, and the random effect model was used to merge the meta-analysis data, regardless of whether the heterogeneity was large or small.Results This study included seven retrospective cohorts, with more than 10720 patients. Most of the patients had esophageal adenocarcinomas. The Meta-analysis showed that NCRT followed by PT increased the patient OS (HR = 0.79, 95% CI 0.74–0.85, P < 0.001). However, further subgroup analysis showed that NCRT + PT might not improve the OS of resected EC patients with a negative lymph node status (HR = 0.82, 95% CI 0.67–1.01, P = 0.124). Further, we showed that NCRT with PT improved the survival of EC patients with a positive lymph node status who underwent resection (HR = 0.78, 95% CI 0.70–0.86, P < 0.001).Conclusion PT may improve the survival of lymph node-positive EC patients previously treated by NCRT. This conclusion may be more applicable to EAC patients treated with NCRT at the ypN + stage.

show abstract

Adjuvant Chemotherapy vs Postoperative Observation Following Preoperative Chemoradiotherapy and Resection in Gastroesophageal Cancer

Cited by 71 publications

References 34 publications

Examining the use of pre‐operative radiation therapy in addition to perioperative chemotherapy: National Cancer Data Base vs. Surveillance, Epidemiology, and End Results

Examining the use of pre‐operative radiation therapy in addition to perioperative chemotherapy: National Cancer Data Base vs. Surveillance, Epidemiology, and End Results

Survival outcomes in patients with gastric and gastroesophageal junction adenocarcinomas treated with perioperative chemotherapy with or without preoperative radiotherapy

Is postoperative chemotherapy necessary for resected esophageal carcinoma after neoadjuvant chemoradiotherapy? A systematic review and meta-analysis

Contact Info

Product

Resources

About