Survival and Recurrence Patterns after Neoadjuvant Docetaxel, Cisplatin, and 5-Fluorouracil (DCF) for Locally Advanced Esophagogastric Adenocarcinoma
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- 作者：Monisha Sudarshan (1)
Thierry Alcindor (1)
Steven Ades (2)
Abdullah Aloraini (1)
Marie van Huyse (1)
Jamil Asselah (1)
Marc David (1)
Dominique Frechette (3)
Sonia Brisson (3)
Michael Thirlwell (1)
Lorenzo Ferri (1)
1. McGill University Health Centre ; Montreal ; QC ; Canada
2. University of Vermont ; Burlington ; VT ; USA
3. Gatineau Hospital ; Gatineau ; QC ; Canada - 刊名：Annals of Surgical Oncology
- 出版年：2015
- 出版时间：January 2015
- 年：2015
- 卷：22
- 期：1
- 页码：324-330
- 全文大小：217 KB
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- 出版者：Springer US
- ISSN：1534-4681
文摘
Introduction We have previously identified Docetaxel, Cisplatin, and 5FU (DCF) as a safe, tolerable, and effective regimen in the neoadjuvant setting for locally advanced adenocarcinoma (ADC) of the esophagus and esophagogastric junction (EGJ). We hypothesized that DCF combined with enhanced surgical control would result in a low rate of local or regional recurrence, and thus reviewed our outcomes with this treatment regimen. Methods A prospectively entered database of all esophageal and EGJ ADC patients resected at a high-volume referral center over 6 years (9/07-9/13) was reviewed for cases treated with curative intent neoadjuvant DCF followed by en bloc resection with extended lymphadenectomy (D2/D3). Recurrences was defined as locoregional (biopsy on endoscopy/regional lymph nodes (LNs)) and distant. Standard statistical techniques were used. Results Of 279 patients with ADC, 86 (85% male, mean age 63 years (interquartile range 56-70)) underwent preoperative DCF and curative intent resection for locally advanced ADC (cT3 93%; cN+ 69%) of the EGJ (54%) or distal esophagus (46%). After median follow-up of 40 months, the overall 5-year survival was 54% and 43 (52%) had recurred at a median time of 14 months. Sites of recurrence included locoregional only in 2 of 45 (4%), distant only in 40 of 45 (89%), and locoregional and distant in 3 of 45 (7%). Discussion The present study demonstrates favourable oncologic outcomes with low local/regional recurrence and an excellent overall 5-year survival after neoadjuvant DCF for esophageal and EGJ ADCs. Because the majority of recurrences were distant, our data support the notion that efforts to improve outcomes in these patients should concentrate on enhancing systemic, rather than local, therapy.