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Recurrence Patterns and Long-term Results After Induction Chemotherapy, Chemoradiotherapy, and Curative Surgery in Patients With Locally Advanced Esophageal Cancer

Steffen, Thomas, MD*; Dietrich, Daniel, PhD; Schnider, Annelies, MD; Kettelhack, Christoph, MD§; Huber, Olivier, MD||; Marti, Walter R., MD; Furrer, Markus, MD#; Gloor, Beat, MD**; Schiesser, Marc, MD*; Thierstein, Sandra; Brauchli, Peter, PhD; Ruhstaller, Thomas, MD†† on behalf of the Swiss Group for Clinical Cancer Research (SAKK)

doi: 10.1097/SLA.0000000000002435
ORIGINAL ARTICLES

Objective: The long-term follow up data of 2 prospective phase II trials is reported (NCT00072033, NCT00445861), which investigated neoadjuvant chemoradiation followed by surgery in patients with esophageal carcinoma. Postoperative complications as well as prognostic factors and patterns of relapse during long-term observation are shown.

Summary of Background Data: Long-term follow-up is often missing in the complex setting of multimodal treatments of esophageal carcinoma; this leads to rather undifferentiated follow-up guidelines for this tumor entity.

Methods: In the first trial, patients received induction chemotherapy followed by chemoradiation and surgery. In the second trial, cetuximab was added to the same neoadjuvant treatment concomitant with induction chemotherapy and chemoradiation.

Results: Eighty-two patients underwent surgery; the median follow-up time was 6.8 and 6.4 years, respectively. Fifty-five percent were diagnosed with adenocarcinoma, 80% clinically node-positive, 68% received transthoracic esophagectomy, and 32% transhiatal or transmediastinal resection. Five patients died postoperatively in-hospital due to complications (6%). The median overall survival was 4.3 years, and the median event-free survival was 2.7 years. Patients with adenocarcinoma rarely relapsed after a 3-year event-free survival. Whereas patients with residual tumor cells after neoadjuvant therapy primarily experienced relapse within the first 2 postoperative years, this in contrast to several patients with complete remission who also experienced late relapses 4 years after surgery.

Conclusion: After curative surgery in a multimodal setting, the histological type and the response to neoadjuvant therapy predicted the time frame of relapse; this knowledge may influence further follow-up guidelines for esophageal carcinoma.

*Department of General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland

SAKK Coordinating Centre, Berne, Switzerland

Department of Visceral, Thoracic and Vascular Surgery, City Hospital Triemli, Zurich, Switzerland

§Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland

||Department of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland

Department of Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland

#Department of Surgery, Cantonal Hospital of Graubünden, Chur, Switzerland

**Department of Visceral Surgery and Medicine, Inselspital University Berne, Berne Switzerland

††Department of Oncology/Hematology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.

Reprints: Thomas Steffen, MD, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9007 St. Gallen, Switzerland. E-mail: thomas.steffen@kssg.ch.

This work was conducted by the Swiss Group for Clinical Cancer Research, and partially supported by Merck Serono Switzerland, Sanofi-Aventis Switzerland, and the Federal Government of Switzerland.

The authors declared no conflicts of interest.

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