Details der Publikation - Postoperative and Pathological Outcomes of CROSS and FLOT as Neoadjuvant Therapy for Esophageal and Junctional Adenocarcinoma

Postoperative and Pathological Outcomes of CROSS and FLOT as Neoadjuvant Therapy for Esophageal and Junctional Adenocarcinoma : An International Cohort Study From the Oesophagogastric Anastomosis Audit (OGAA)

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved..

OBJECTIVE: This study aimed to compare the postoperative and pathological outcomes between carboplatin, paclitaxel, radiotherapy (CROSS) and 5-FU, leucovorine, oxaliplatin and docetaxel (FLOT) in esophageal adenocarcinoma (EAC) patients from an international, multicenter cohort.

SUMMARY OF BACKGROUND DATA: Ongoing debate exists around optimum approach to locally advanced EAC, with proponents for perioperative chemotherapy, such as FLOT, or multimodal therapy, in particular the CROSS regimen.

METHODS: Patients undergoing CROSS (n = 350) and FLOT (n = 368), followed by curative esophagectomy for EAC were identified from the Oesophagogastric Anastomosis Audit.

RESULTS: The 90-day mortality was higher after CROSS than FLOT (5% vs 1%, P = 0.005), even on adjusted analyses [odds ratio (OR): 3.97, confidence interval (CI) 95% : 1.34-13.67]. Postoperative mortality in CROSS were related to higher pulmonary (74% vs 60%) and cardiac complications (42% vs 20%) compared to FLOT. CROSS was associated with higher pathologic complete response (pCR) rates (18% vs 10%, P = 0.004) and margin-negative resections (93% vs 76%, P < 0.001) compared with FLOT. On adjusted analyses, CROSS was associated with higher pCR rates (OR: 2.05, CI 95% : 1.26-3.34) and margin-negative resections (OR: 4.55, CI 95% : 2.70-7.69) compared to FLOT.

CONCLUSIONS: This study provides real-world data CROSS was associated with higher 90-day mortality than FLOT, related to cardio-pulmonary complications with CROSS. These warrant a further review into causes and mechanisms in selected patients, and at minimum suggest the need for strict radiation therapy quality assurance. Research into impact of higher pCR rates and R0 resections with CROSS compared to FLOT on long-term survival is needed.

Medienart:	E-Artikel

Erscheinungsjahr:	2023
Erschienen:	2023

Enthalten in:	Zur Gesamtaufnahme - volume:277
Enthalten in:	Annals of surgery - 277(2023), 5 vom: 01. Mai, Seite e1026-e1034

Sprache:	Englisch

Beteiligte Personen:	Oesophago-Gastric Anastomotic Audit (OGAA) Collaborative [VerfasserIn] Alderson, D [Sonstige Person] Bundred, J [Sonstige Person] Rpt, Evans [Sonstige Person] Gossage, J [Sonstige Person] Griffiths, E A [Sonstige Person] Jefferies, B [Sonstige Person] Kamarajah, S K [Sonstige Person] McKay, S [Sonstige Person] Mohamed [Sonstige Person] Nepogodiev, D [Sonstige Person] Siaw-Acheampong, K [Sonstige Person] Singh, P [Sonstige Person] van Hillegersberg, R [Sonstige Person] Vohra, R [Sonstige Person] Wanigasooriya, K [Sonstige Person] Whitehouse, T [Sonstige Person] Gjata, A [Sonstige Person] Moreno, J I [Sonstige Person] Takeda, F R [Sonstige Person] Kidane, B [Sonstige Person] Guevara Castro, R [Sonstige Person] Harustiak, T [Sonstige Person] Bekele, A [Sonstige Person] Kechagias, A [Sonstige Person] Gockel [Sonstige Person] Kennedy, A [Sonstige Person] Da Roit, A [Sonstige Person] Bagajevas, A [Sonstige Person] Azagra, J S [Sonstige Person] Mahendran, H A [Sonstige Person] Mejía-Fernández, L [Sonstige Person] Wijnhoven, Bpl [Sonstige Person] El Kafsi, J [Sonstige Person] Sayyed, R H [Sonstige Person] Sousa, M [Sonstige Person] Sampaio, A S [Sonstige Person] Negoi [Sonstige Person] Blanco, R [Sonstige Person] Wallner, B [Sonstige Person] Schneider, P M [Sonstige Person] Hsu, P K [Sonstige Person] Isik, A [Sonstige Person] Gananadha, S [Sonstige Person] Wills [Sonstige Person] Devadas, M [Sonstige Person] Duong, C [Sonstige Person] Talbot, M [Sonstige Person] Hii, M W [Sonstige Person] Jacobs, R [Sonstige Person] Andreollo, N A [Sonstige Person] Johnston, B [Sonstige Person] Darling, G [Sonstige Person] Isaza-Restrepo, A [Sonstige Person] Rosero, G [Sonstige Person] Arias-Amézquita, F [Sonstige Person] Raptis, D [Sonstige Person] Gaedcke, J [Sonstige Person] Reim, D [Sonstige Person] Izbicki, J [Sonstige Person] Egberts, J H [Sonstige Person] Dikinis, S [Sonstige Person] Kjaer, D W [Sonstige Person] Larsen, M H [Sonstige Person] Achiam, M P [Sonstige Person] Saarnio, J [Sonstige Person] Theodorou, D [Sonstige Person] Liakakos, T [Sonstige Person] Korkolis, D P [Sonstige Person] Robb, W B [Sonstige Person] Collins, C [Sonstige Person] Murphy, T [Sonstige Person] Reynolds, J [Sonstige Person] Tonini [Sonstige Person] Migliore, M [Sonstige Person] Bonavina, L [Sonstige Person] Valmasoni, M [Sonstige Person] Bardini, R [Sonstige Person] Weindelmayer, J [Sonstige Person] Terashima, M [Sonstige Person] White, R E [Sonstige Person] Alghunaim, E [Sonstige Person] Elhadi, M [Sonstige Person] Leon-Takahashi, A M [Sonstige Person] Medina-Franco, H [Sonstige Person] Lau, P C [Sonstige Person] Okonta, K E [Sonstige Person] Heisterkamp, J [Sonstige Person] Rosman, C [Sonstige Person] van Hillegersberg, R [Sonstige Person] Beban, G [Sonstige Person] Babor, R [Sonstige Person] Gordon, A [Sonstige Person] Rossaak, J I [Sonstige Person] Pal, Kmi [Sonstige Person] Qureshi, A U [Sonstige Person] Naqi, S A [Sonstige Person] Syed, A A [Sonstige Person] Barbosa, J [Sonstige Person] Vicente, C S [Sonstige Person] Leite, J [Sonstige Person]

Links:	Volltext

Themen:	Journal Article Multicenter Study

Anmerkungen:	Date Completed 05.12.2023 Date Revised 19.12.2023 published: Print-Electronic Citation Status MEDLINE

doi:	10.1097/SLA.0000000000005394

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	NLM336329245

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245	1	0	\|a Postoperative and Pathological Outcomes of CROSS and FLOT as Neoadjuvant Therapy for Esophageal and Junctional Adenocarcinoma \|b An International Cohort Study From the Oesophagogastric Anastomosis Audit (OGAA)
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520			\|a Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
520			\|a OBJECTIVE: This study aimed to compare the postoperative and pathological outcomes between carboplatin, paclitaxel, radiotherapy (CROSS) and 5-FU, leucovorine, oxaliplatin and docetaxel (FLOT) in esophageal adenocarcinoma (EAC) patients from an international, multicenter cohort
520			\|a SUMMARY OF BACKGROUND DATA: Ongoing debate exists around optimum approach to locally advanced EAC, with proponents for perioperative chemotherapy, such as FLOT, or multimodal therapy, in particular the CROSS regimen
520			\|a METHODS: Patients undergoing CROSS (n = 350) and FLOT (n = 368), followed by curative esophagectomy for EAC were identified from the Oesophagogastric Anastomosis Audit
520			\|a RESULTS: The 90-day mortality was higher after CROSS than FLOT (5% vs 1%, P = 0.005), even on adjusted analyses [odds ratio (OR): 3.97, confidence interval (CI) 95% : 1.34-13.67]. Postoperative mortality in CROSS were related to higher pulmonary (74% vs 60%) and cardiac complications (42% vs 20%) compared to FLOT. CROSS was associated with higher pathologic complete response (pCR) rates (18% vs 10%, P = 0.004) and margin-negative resections (93% vs 76%, P < 0.001) compared with FLOT. On adjusted analyses, CROSS was associated with higher pCR rates (OR: 2.05, CI 95% : 1.26-3.34) and margin-negative resections (OR: 4.55, CI 95% : 2.70-7.69) compared to FLOT
520			\|a CONCLUSIONS: This study provides real-world data CROSS was associated with higher 90-day mortality than FLOT, related to cardio-pulmonary complications with CROSS. These warrant a further review into causes and mechanisms in selected patients, and at minimum suggest the need for strict radiation therapy quality assurance. Research into impact of higher pCR rates and R0 resections with CROSS compared to FLOT on long-term survival is needed
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700	1		\|a Kidane, B \|e investigator \|4 oth
700	1		\|a Guevara Castro, R \|e investigator \|4 oth
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700	1		\|a Kechagias, A \|e investigator \|4 oth
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700	1		\|a Kennedy, A \|e investigator \|4 oth
700	1		\|a Da Roit, A \|e investigator \|4 oth
700	1		\|a Bagajevas, A \|e investigator \|4 oth
700	1		\|a Azagra, J S \|e investigator \|4 oth
700	1		\|a Mahendran, H A \|e investigator \|4 oth
700	1		\|a Mejía-Fernández, L \|e investigator \|4 oth
700	1		\|a Wijnhoven, Bpl \|e investigator \|4 oth
700	1		\|a El Kafsi, J \|e investigator \|4 oth
700	1		\|a Sayyed, R H \|e investigator \|4 oth
700	1		\|a Sousa, M \|e investigator \|4 oth
700	1		\|a Sampaio, A S \|e investigator \|4 oth
700	1		\|a Negoi \|c 1st \|e investigator \|4 oth
700	1		\|a Blanco, R \|e investigator \|4 oth
700	1		\|a Wallner, B \|e investigator \|4 oth
700	1		\|a Schneider, P M \|e investigator \|4 oth
700	1		\|a Hsu, P K \|e investigator \|4 oth
700	1		\|a Isik, A \|e investigator \|4 oth
700	1		\|a Gananadha, S \|e investigator \|4 oth
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700	1		\|a Devadas, M \|e investigator \|4 oth
700	1		\|a Duong, C \|e investigator \|4 oth
700	1		\|a Talbot, M \|e investigator \|4 oth
700	1		\|a Hii, M W \|e investigator \|4 oth
700	1		\|a Jacobs, R \|e investigator \|4 oth
700	1		\|a Andreollo, N A \|e investigator \|4 oth
700	1		\|a Johnston, B \|e investigator \|4 oth
700	1		\|a Darling, G \|e investigator \|4 oth
700	1		\|a Isaza-Restrepo, A \|e investigator \|4 oth
700	1		\|a Rosero, G \|e investigator \|4 oth
700	1		\|a Arias-Amézquita, F \|e investigator \|4 oth
700	1		\|a Raptis, D \|e investigator \|4 oth
700	1		\|a Gaedcke, J \|e investigator \|4 oth
700	1		\|a Reim, D \|e investigator \|4 oth
700	1		\|a Izbicki, J \|e investigator \|4 oth
700	1		\|a Egberts, J H \|e investigator \|4 oth
700	1		\|a Dikinis, S \|e investigator \|4 oth
700	1		\|a Kjaer, D W \|e investigator \|4 oth
700	1		\|a Larsen, M H \|e investigator \|4 oth
700	1		\|a Achiam, M P \|e investigator \|4 oth
700	1		\|a Saarnio, J \|e investigator \|4 oth
700	1		\|a Theodorou, D \|e investigator \|4 oth
700	1		\|a Liakakos, T \|e investigator \|4 oth
700	1		\|a Korkolis, D P \|e investigator \|4 oth
700	1		\|a Robb, W B \|e investigator \|4 oth
700	1		\|a Collins, C \|e investigator \|4 oth
700	1		\|a Murphy, T \|e investigator \|4 oth
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700	1		\|a Alghunaim, E \|e investigator \|4 oth
700	1		\|a Elhadi, M \|e investigator \|4 oth
700	1		\|a Leon-Takahashi, A M \|e investigator \|4 oth
700	1		\|a Medina-Franco, H \|e investigator \|4 oth
700	1		\|a Lau, P C \|e investigator \|4 oth
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700	1		\|a Rosman, C \|e investigator \|4 oth
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700	1		\|a Gordon, A \|e investigator \|4 oth
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700	1		\|a Syed, A A \|e investigator \|4 oth
700	1		\|a Barbosa, J \|e investigator \|4 oth
700	1		\|a Vicente, C S \|e investigator \|4 oth
700	1		\|a Leite, J \|e investigator \|4 oth
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Postoperative and Pathological Outcomes of CROSS and FLOT as Neoadjuvant Therapy for Esophageal and Junctional Adenocarcinoma : An International Cohort Study From the Oesophagogastric Anastomosis Audit (OGAA)

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