Background:Neoadjuvant chemoradiation with esophagectomy is standard management for locally advanced esophageal adenocarcinoma. Induction chemotherapy with a tailored approach to chemoradiation based on metabolic response to therapy on PET was explored as an alternative strategy in the CALGB 80803 trial. We sought to describe real-world institutional experience implementing this approach outside of a clinical trial.Methods:Patients who were treated with induction fluorouracil-leucovorin-oxaliplatin (FOLFOX) or fluorouracil-leucovorin-oxaliplatin-docetaxel (FLOT) with tailored chemoradiation based on PET response and subsequent esophagectomy were identified from a prospectively maintained database. Primary outcomes were pathologic complete response (pCR) and overall survival (OS) following completion of all therapy.Results:There were 35 patients who completed induction chemotherapy, chemoradiation, and esophagectomy. Thirty-three completed restaging PET following induction chemotherapy with metabolic response seen in 76% (n = 25/33). The pCR rate was 31% (n = 11/35) and the ypN0 rate was 71% (n = 25/35). Among the patients who demonstrated metabolic response to induction FOLFOX/FLOT and subsequently continued fluorouracil-based chemoradiation, the pCR rate was 39% (n = 9/23). The rate of pathologically negative lymph nodes in this group was high (n = 19/23, 83%) with 100% R0 resection rate (n = 23/23). With the median follow-up of 43 months, the median OS was not reached for this group and was significantly longer than the OS for the remainder of the cohort (p= 0.027,p= 0.046 adjusted for clinical stage).Conclusions:Induction FOLFOX/FLOT chemotherapy with evaluation of sensitivity via metabolic response and tailored chemoradiation seems to lead to high pCR and ypN0 rates in high-risk patients with adenocarcinoma of the esophagus and GE junction. This approach in clinical practice seems to recapitulate encouraging results in clinical trials.
背景：新辅助放化疗联合食管切除术是局部晚期食管腺癌的标准治疗方案。CALGB 80803试验探索了诱导化疗联合基于PET代谢反应个体化放化疗的替代策略。本研究旨在描述该方案在临床试验外的真实世界机构应用经验。 方法：从前瞻性维护数据库中筛选接受氟尿嘧啶-亚叶酸-奥沙利铂（FOLFOX）或氟尿嘧啶-亚叶酸-奥沙利铂-多西他赛（FLOT）诱导化疗，并根据PET反应进行个体化放化疗及后续食管切除术的患者。主要观察指标为完成全部治疗后的病理完全缓解率（pCR）和总生存期（OS）。 结果：共35例患者完成诱导化疗、放化疗及食管切除术。其中33例在诱导化疗后完成再分期PET检查，76%（25/33）出现代谢反应。总体pCR率为31%（11/35），ypN0率为71%（25/35）。在诱导FOLFOX/FLOT化疗出现代谢反应并继续接受氟尿嘧啶为基础放化疗的患者亚组中，pCR率达39%（9/23），该组病理淋巴结阴性率较高（19/23，83%），R0切除率达100%（23/23）。中位随访43个月，该亚组中位OS尚未达到，且经临床分期校正后显著优于队列其余患者（p=0.027，校正后p=0.046）。 结论：对于食管及胃食管结合部腺癌高危患者，采用FOLFOX/FLOT诱导化疗并通过代谢反应评估敏感性，继而实施个体化放化疗的策略，可获得较高的pCR率和ypN0率。该方案在临床实践中的应用效果与临床试验的积极结果相吻合。
肿瘤(癌症)患者之家