17 - Freie Mitteilung
15. Mai 2019, 13:30 - 15:00, Bellavista 2, 6. OG
Outcome of patients with locally advanced esophageal cancer treated accordingly to the neoadjuvant CROSS regimen: Are the results of the original study reproducible?
M. Winiker, P. Allemann, S. Mantziari, N. Demartines, M. Schäfer, Presenter: M. Winiker (Lausanne)
The CROSS regimen is considered as the current standard of neoadjuvant treatment for locally advanced esophageal cancer in Europe. Little is known whether the excellent results of the original CROSS trial are reproducible. This study compared the original CROSS study to patients who underwent a CROSS regimen in a Swiss tertiary referral center.
Retrospective assessment of patients undergoing elective oncological esophagectomy from 01/2013 to 06/2018 who received a neoadjuvant CROSS regimen. While surgery was centralized, neoadjuvant therapy was performed in several oncological departments. Patient characteristics, perioperative parameters, and survival were compared to published CROSS results. Data were retrieved from our prospectively maintained institutional database. Survival was estimated using the Kaplan-Meier method.
There were 66 patients (m/f 55/11, mean age 63 years) with 36 adenocarcinoma (54.5%), 29 squamous cell carcinoma (44%), and one other tumor (1.5%). 58 (88%) patients had T3 tumors, and 49 (74%) patients were node positive. Only 11 (17%) patients received <5 cycles of chemotherapy, and 63 (95.5%) patients had 23 fractions of radiotherapy. 50 patients (77.3%) underwent surgery >6 weeks after the end of neoadjuvant therapy. The complete pathological response rate was 27.3% (18 patients), and the R0 resection rate was 81.5% (53 patients). The 30d-mortality was 6% (4 patients). Anastomotic leakage occurred in 36%. The mean overall survival was 39 months. The median follow-up was 13 months. Anastomotic leakage significantly shortened long-term survival (37 months vs. 32 months, p=0.027). Compared to the original CROSS study, our patients were slightly older (63y vs. 60y) and had poorer performance status. Squamous cell carcinoma were more frequent (44% vs. 23%), while pre-treatment T and N stages and tumor lengths were similar. Postoperatively, complete pathological response rates and ypN0 rates were similar, but the down-staging effect of the T stage was less in our series. The R0 resection rates could not be achieved (81.5% vs. 94%), as it was for anastomotic leakages (36% vs. 22%). Median overall survival of our series could not be determined as the survival curve did not drop to ≤0.5, which is related to the short follow-up of 13 months.
The outcome of the original CROSS study was only partially reproducible in our center.