Outcomes for Esophageal Squamous Cell Carcinoma Treated with Curative Intent in a Western Cohort: Should Multimodal Therapy Be the Gold Standard?

Sheil, Fiachra; Donohoe, Claire L.; King, Sinéad; O’Toole, Dermot; Cunningham, Moya; Cuffe, Sinéad; Ravi, Narayanasamy; Reynolds, John V.

doi:10.1007/s00268-017-4289-8

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…The inclusion criteria were met by 35 articles describing 32 studies (21 Western and 11 Asian; Fig. 1) [7, 13, 14, 17–48]. Of the 35 articles included, two were RCTs and 33 were observational.…”

Section: Resultsmentioning

confidence: 99%

Definitive Chemoradiotherapy Versus Trimodality Therapy for Resectable Oesophageal Carcinoma: Meta‐analyses and Systematic Review of Literature

et al. 2019

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Background Standard therapy for loco-regionally advanced, resectable oesophageal carcinoma is trimodality therapy (TMT) consisting of neoadjuvant chemoradiotherapy and oesophagectomy. Evidence of survival advantage of TMT over organ-preserving definitive chemoradiotherapy (dCRT) is inconclusive. The aim of this study is to compare survival between TMT and dCRT. Methods A systematic review and meta-analyses were conducted. Randomised controlled trials and observational studies on resectable, curatively treated, oesophageal carcinoma patients above 18 years were included. Three online databases were searched for studies comparing TMT with dCRT. Primary outcomes were 1-, 2-, 3-and 5-year overall survival rates. Risk of bias was assessed using the Cochrane risk of bias tools for RCTs and cohort studies. Quality of evidence was evaluated according to Grading of Recommendation Assessment, Development and Evaluation. Results Thirty-two studies described in 35 articles were included in this systematic review, and 33 were included in the meta-analyses. Two-, three-and five-year overall survival was significantly lower in dCRT compared to TMT, with relative risks (RRs) of 0.69 (95% CI 0.57-0.83), 0.76 (95% CI 0.63-0.92) and 0.57 (95% CI 0.47-0.71), respectively. When only analysing studies with equal patient groups at baseline, no significant differences for 2-, 3and 5-year overall survival were found with RRs of 0.83 (95% CI 0.62-1.10), 0.81 (95% CI 0.57-1.14) and 0.63 (95% CI 0.36-1.12). Conclusion These meta-analyses do not show clear survival advantage for TMT over dCRT. Only a non-significant trend towards better survival was seen, assuming comparable patient groups at baseline. Non-operative management of oesophageal carcinoma patients might be part of a personalised and tailored treatment approach in future. However, to date hard evidence proving its non-inferiority compared to operative management is lacking.

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Section: Resultsmentioning

confidence: 99%

Definitive Chemoradiotherapy Versus Trimodality Therapy for Resectable Oesophageal Carcinoma: Meta‐analyses and Systematic Review of Literature

et al. 2019

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“…The poor 5-year OS reported in this study is not exclusive to Brazil, as similar outcomes have been reported in other observational studies. 22 , 23 Along this line, Chen et al 24 reported a 5-year OS of 20% for patients with locally advanced ESCC treated with dCRT. Similar outcomes have been reported by the WECC esophageal study group, with a 5-year OS of 30% in patients with clinical stage II and III ESCC.…”

Section: Discussionmentioning

confidence: 97%

Chemoradiotherapy With or Without Surgery for Esophageal Squamous Cancer According to Hospital Volume

Duarte

Pereira

Lopes

et al. 2020

JCO Global Oncology

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PURPOSE Esophageal squamous cell cancer (ESCC) is still associated with a dismal prognosis. However, surgical series have shown that high-volume hospitals have better outcomes and that the impact of center volume on definitive chemoradiotherapy (dCRT) or CRT plus surgery (CRT + S) remains unknown. METHODS We performed a retrospective analysis of patients with locally advanced stage II-III (non-T4) ESCC treated with dCRT or CRT + S in São Paulo state, Brazil. Descriptive variables were assessed with the χ2 test after categorization of hospital volume (high-volume [HV] center, top 5 higher volume, or low-volume [LV] center). Overall survival (OS) was assessed with Kaplan-Meier curves, log-rank tests, and Cox proportional hazards. Finally, an interaction test between each facility’s treatments was performed. RESULTS Between 2000 and 2013, 1,347 patients were analyzed (77% treated with dCRT and 65.7% in HV centers) with a median follow-up of 23.7 months. The median OS for dCRT was 14.1 months (95% CI, 13.3 to 15.3 months) and for CRT + S, 20.6 months (95% CI, 16.1 to 24.9 months). In the multivariable analysis, dCRT was associated with worse OS (hazard ratio [HR], 1.38; 95% CI, 1.19 to 1.61; P < .001) compared with CRT + S. HV hospitals were associated with better OS (HR, 0.82; 95% CI, 0.71 to 0.94; P = .004) compared with LV hospitals. Importantly, CRT + S superiority was restricted to HV hospitals (dCRT v CRT + S: HR, 1.56; 95% CI, 1.29 to 1.89; P < .001), while in LV hospitals, there was no statistically significant difference (HR, 1.23; 95% CI, 0.88 to 1.43; P = .350), with a significant interaction test ( Pinteraction = .035). CONCLUSION Our data show that CRT + S is superior to dCRT in the treatment of ESCC exclusively in HV hospitals, which favors the literature trend to centralize the treatment of ESCC in HV centers.

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“…For FLOT, rates of pCR were variable, with one study reporting 0 and a prospective Italian study reporting rates of 7% [5, 6]. Real-world studies report pCR ranging from 32% to 43% for CROSS, though these include squamous cell carcinoma which is more likely to achieve a pCR [5‒8, 9].…”

Section: Discussionmentioning

confidence: 99%

Real-World Outcomes of FLOT versus CROSS Regimens for Patients with Oesophagogastric Cancers

Shahnam,

Nindra,

McNamee

et al. 2023

Gastrointest Tumors

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Introduction: Treatment of oesophageal (OC), gastro-oesophageal junction (GOJ), and gastric cancer (GC) includes either neoadjuvant Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) for OC or GOJ or perioperative 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) for OC, GOJ, and GC adenocarcinomas. This study aims to describe the real-world outcomes of patients with GC, GOJ, and OC treated with FLOT or CROSS and identify variables associated with efficacy through exploratory analysis. We also aimed to evaluate the comparison of FLOT and CROSS for the treatment of OC and GOJ adenocarcinomas. Methods: This is a retrospective observational study of patients with locally advanced OC, GOJ, or GC treated with FLOT or CROSS between January 2015 and June 2021 in 5 cancer centres across Sydney, Australia. Long-rank test was used to compare survival estimated between subgroups. Hazard ratios for univariate and multivariate analyses were estimated with Cox proportional regression. Results: The study included 168 patients. The 24-month relapse-free survival (RFS) and overall survival (OS) for FLOT were 59% and 69%, respectively. The median RFS was 29.6 months and median OS was not reached. For CROSS, the 24-month RFS and OS were 55% and 63% with a median RFS and OS of 28.5 and 40.2 months, respectively. There was no difference in OS and RFS between the treatments. FLOT was less tolerable than CROSS with more dose reductions, treatment discontinuation, and clinically relevant grade 3 and 4 toxicity. Neutrophil lymphocyte ratio was associated with survival for both treatments. Conclusion: Similar efficacy outcomes were seen in this real-world population compared to the clinical trials for FLOT and CROSS.

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Outcomes for Esophageal Squamous Cell Carcinoma Treated with Curative Intent in a Western Cohort: Should Multimodal Therapy Be the Gold Standard?

Cited by 9 publications

References 29 publications

Definitive Chemoradiotherapy Versus Trimodality Therapy for Resectable Oesophageal Carcinoma: Meta‐analyses and Systematic Review of Literature

Definitive Chemoradiotherapy Versus Trimodality Therapy for Resectable Oesophageal Carcinoma: Meta‐analyses and Systematic Review of Literature

Chemoradiotherapy With or Without Surgery for Esophageal Squamous Cancer According to Hospital Volume

Real-World Outcomes of FLOT versus CROSS Regimens for Patients with Oesophagogastric Cancers

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