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J Clin Oncol. 2014 Feb 10;32(5):385-91. doi: 10.1200/JCO.2013.51.2186. Epub 2014 Jan 13.

Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials.

Author information

1
Vera Oppedijk, Rob van Os, Dick J. Richel, Mark I. van Berge Henegouwen, and Maarten C.C.M. Hulshof, Academic Medical Center, Amsterdam; Patty H. Spruit, Vrije Universiteit Medical Center, Amsterdam; Ate van der Gaast, Jan J.B. van Lanschot, Pieter van Hagen, and Caroline M. van Rij, Erasmus Medical Center, Rotterdam; Maurice J. van der Sangen, Catharina Hospital, Eindhoven; Jannet C. Beukema, University Medical Center, Groningen; Heidi Rütten, Radboud University Medical Center, Nijmegen; and Janny G. Reinders, Arnhems Radiotherapeutisch Instituut, Arnhem, the Netherlands.

Abstract

PURPOSE:

To analyze recurrence patterns in patients with cancer of the esophagus or gastroesophageal junction treated with either preoperative chemoradiotherapy (CRT) plus surgery or surgery alone.

PATIENTS AND METHODS:

Recurrence pattern was analyzed in patients from the previously published CROSS I and II trials in relation to radiation target volumes. CRT consisted of five weekly courses of paclitaxel and carboplatin combined with a concurrent radiation dose of 41.4 Gy in 1.8-Gy fractions to the tumor and pathologic lymph nodes with margin.

RESULTS:

Of the 422 patients included from 2001 to 2008, 418 were available for analysis. Histology was mostly adenocarcinoma (75%). Of the 374 patients who underwent resection, 86% were allocated to surgery and 92% to CRT plus surgery. On January 1, 2011, after a minimum follow-up of 24 months (median, 45 months), the overall recurrence rate in the surgery arm was 58% versus 35% in the CRT plus surgery arm. Preoperative CRT reduced locoregional recurrence (LRR) from 34% to 14% (P < .001) and peritoneal carcinomatosis from 14% to 4% (P < .001). There was a small but significant effect on hematogenous dissemination in favor of the CRT group (35% v 29%; P = .025). LRR occurred in 5% within the target volume, in 2% in the margins, and in 6% outside the radiation target volume. In 1%, the exact site in relation to the target volume was unclear. Only 1% had an isolated infield recurrence after CRT plus surgery.

CONCLUSION:

Preoperative CRT in patients with esophageal cancer reduced LRR and peritoneal carcinomatosis. Recurrence within the radiation target volume occurred in only 5%, mostly combined with outfield failures.

PMID:
24419108
DOI:
10.1200/JCO.2013.51.2186
[Indexed for MEDLINE]

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