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

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

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.

Publication types

  • Clinical Trial, Phase II
  • Clinical Trial, Phase III
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / secondary
  • Adenocarcinoma / therapy*
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carboplatin / administration & dosage
  • Carcinoma, Squamous Cell / secondary
  • Carcinoma, Squamous Cell / therapy*
  • Chemotherapy, Adjuvant* / adverse effects
  • Dose Fractionation, Radiation
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / therapy*
  • Esophagectomy* / adverse effects
  • Esophagogastric Junction* / drug effects
  • Esophagogastric Junction* / pathology
  • Esophagogastric Junction* / radiation effects
  • Esophagogastric Junction* / surgery
  • Female
  • Gastrectomy / adverse effects*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoadjuvant Therapy* / adverse effects
  • Neoplasm Recurrence, Local / prevention & control*
  • Paclitaxel / administration & dosage
  • Proportional Hazards Models
  • Risk Factors
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / therapy*
  • Time Factors
  • Treatment Outcome

Substances

  • Carboplatin
  • Paclitaxel

Associated data

  • NTR/NTR487