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J Clin Oncol. 2015 Nov 20;33(33):3866-73. doi: 10.1200/JCO.2014.59.9092. Epub 2015 Jul 20.

Salvage Surgery After Chemoradiotherapy in the Management of Esophageal Cancer: Is It a Viable Therapeutic Option?

Author information

1
Sheraz Markar, Imperial College, London, United Kingdom; Caroline Gronnier, Christophe Mariette, and Alain Duhamel, Site de Recherche Intégrée sur le Cancer OncoLille; North of France University; University Hospital of Lille; Caroline Gronnier and Christophe Mariette, INSERM UMR S-1172, Jean Pierre Aubert Research Center, Lille; Arnaud Pasquer and Christophe Mariette, Edouard Herriot University Hospital, Lyon; Jérémie Théreaux, Cavale Blanche University Hospital, Brest; Mael Chalret du Rieu, Purpan University Hospital, Toulouse; Jérémie H. Lefevre, Saint Antoine University Hospital, Paris; Kathleen Turner, Pontchaillou University Hospital, Rennes; and Guillaume Luc, Haut-Levêque University Hospital, Bordeaux, France.
2
Sheraz Markar, Imperial College, London, United Kingdom; Caroline Gronnier, Christophe Mariette, and Alain Duhamel, Site de Recherche Intégrée sur le Cancer OncoLille; North of France University; University Hospital of Lille; Caroline Gronnier and Christophe Mariette, INSERM UMR S-1172, Jean Pierre Aubert Research Center, Lille; Arnaud Pasquer and Christophe Mariette, Edouard Herriot University Hospital, Lyon; Jérémie Théreaux, Cavale Blanche University Hospital, Brest; Mael Chalret du Rieu, Purpan University Hospital, Toulouse; Jérémie H. Lefevre, Saint Antoine University Hospital, Paris; Kathleen Turner, Pontchaillou University Hospital, Rennes; and Guillaume Luc, Haut-Levêque University Hospital, Bordeaux, France. christophe.mariette@chru-lille.fr.

Abstract

PURPOSE:

The aim of this large multicenter study was to assess the impact of salvage esophagectomy after definitive chemoradiotherapy (SALV) on clinical outcome.

PATIENTS AND METHODS:

Data from consecutive adult patients undergoing resection for esophageal cancer in 30 European centers from 2000 to 2010 were collected. First, groups undergoing SALV (n = 308) and neoadjuvant chemoradiotherapy followed by planned esophagectomy (NCRS; n = 540) were compared. Second, patients who benefited from SALV for persistent (n = 234) versus recurrent disease (n = 74) were compared. Propensity score matching and multivariable analyses were used to compensate for differences in some baseline characteristics.

RESULTS:

SALV versus NCRS groups: In-hospital mortality was similar in both groups (8.4% v 9.3%). The only significant differences in complications were seen for anastomotic leak (17.2% v 10.7%; P = .007) and surgical site infection, which were both more frequent in the SALV group. At 3 years, groups had similar overall (43.3% v 40.1%; P = .542) and disease-free survival (39.2% v 32.8%; P = .232) after matching, along with a similar recurrence pattern. Persistent versus recurrent disease groups: There were no significant differences between groups in incidence of in-hospital mortality or major complications. At 3 years, overall (40.9% v 56.2%; P = .046) and disease-free survival (36.6% v 51.6%; P = .095) were lower in the persistent disease group.

CONCLUSION:

The results of this large multicenter study from the modern era suggest that SALV can offer acceptable short- and long-term outcomes in selected patients at experienced centers. Persistent cancer after definitive chemoradiotherapy seems to be more biologically aggressive, with poorer survival compared with recurrent cancer.

PMID:
26195702
DOI:
10.1200/JCO.2014.59.9092
[Indexed for MEDLINE]

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