Modification of preoperative radiochemotherapy for esophageal cancer (CROSS protocol) is safe and efficient with no impa
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ORIGINAL ARTICLE
Modification of preoperative radiochemotherapy for esophageal cancer (CROSS protocol) is safe and efficient with no impact on surgical morbidity Matthias Paireder1 · Gerd Jomrich1 · Ivan Kristo1 · Reza Asari1 · Erwin Rieder1 · Andrea Beer2 · Aysegül Ilhan-Mutlu3 · Matthias Preusser3 · Rainer Schmid4 · Sebastian F. Schoppmann1 Received: 24 July 2019 / Accepted: 3 February 2020 © The Author(s) 2020
Abstract Purpose Neoadjuvant radiochemotherapy (RCTH) is proven to be highly effective in the treatment of esophageal cancer (EC). We investigated oncological outcome and morbidity in patients treated with a modified CROSS protocol followed by esophagectomy at our institution. Methods Patients with EC receiving neoadjuvant RCTH with paclitaxel and carboplatin and concurrent radiotherapy (46 Gy) followed by esophagectomy were included in this retrospective analysis. Histopathological response, overall survival (OS) and recurrence-free interval (RFI) as well as perioperative morbidity were investigated. Results Thirty-six patients (86.1% male, mean age 61.3 years, standard deviation 11.52) received neoadjuvant RCTH before surgery. Sixteen patients (44.4%) were treated for squamous cell cancer, whereas 20 patients (55.6%) had adenocarcinoma. The majority (75%) underwent abdominothoracic esophageal resection. Major complications occurred in 7 patients (19.5%) including anastomotic leakage in 4 patients (11.1%). A R0 resection was achieved in 97.2%. A complete pathological remission was seen in 13 patients (36.1%). Major response, classified as Mandard tumor regression grade 1 and 2, was found in 26 patients (72.2%). Median OS and RFI were not reached. Conclusions Neoadjuvant radiotherapy with 46 Gy and concomitant chemotherapy with paclitaxel and carboplatin for the treatment of locally advanced esophageal carcinoma is safe and effective. The results of this modified radiotherapy protocol are encouraging and should be considered in future patient treatment and study designs.
Keywords Neoadjuvant radiochemotherapy · Esophagus · Esophageal resection · CROSS protocol · Prognosis
Background Esophageal cancer (EC) is a rare tumor entity associated with a dramatically growing incidence [1]. Despite im Sebastian F. Schoppmann, MD, FACS
[email protected] 1
Department of Surgery, Upper GI Service, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
2
Department of Pathology, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria
3
Clinical Division of Oncology, Department of Medicine I and Comprehensive Cancer Center, GET-Unit, Medical University of Vienna, Vienna, Austria
4
Department of Radiation Oncology, Comprehensive Cancer Center GET-Unit, Medical University of Vienna, Vienna, Austria
provement in therapy, patients are still confronted with poor prognosis [2]. In locally advanced stage, the multimodal approach gained significant relevance in the treatment of EC [3, 4]. Importantly, the randomized contr
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