Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Ronellenfitsch, Ulrich; Schwarzbach, Matthias; Hofheinz, Ralf; Kienle, Peter; Kieser, Meinhard; Slanger, Tracy; Jensen, Katrin

doi:10.1002/14651858.cd008107.pub2

Cited by 122 publications

(103 citation statements)

References 58 publications

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“…The equivalent recommendation for chemotherapy or RCT in the preoperative phase was also justified on the basis of toxicity [55]. In a recent review, Crehange recommended primarily preoperative chemotherapy for patients with AEG II and III [42], whereas Renellenfitsch and colleagues clearly supported RCT in the lower esophagus in a recent meta-analysis [64]. In summary, the first German evidence-based and expert consensus guideline clearly defined molecular markers, diagnosis and staging, as well as particularly endoscopic and perioperative treatment recommendations, for locallyadvanced esophagogastric cancers.…”

Section: Discussionmentioning

confidence: 99%

International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus

et al. 2014

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Background Clinical guidelines are essential in implementing and maintaining nationwide stage-specific diagnostic and therapeutic standards. In 2011, the first German expert consensus guideline defined the evidence for diagnosis and treatment of early and locally advanced esophagogastric cancers. Here, we compare this guideline with other national guidelines as well as current literature.Methods The German S3-guideline used an approved development process with de novo literature research, international guideline adaptation, or good clinical practice. Other recent evidence-based national guidelines and current references were compared with German recommendations.

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Section: Discussionmentioning

confidence: 99%

International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus

et al. 2014

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“…40 Similarly, a Cochrane review including 14 randomized trials of AC of the stomach, EGJ, and lower esophagus also demonstrated that preoperative chemotherapy was associated with a significantly longer OS. 43 A meta-analysis reported by Gebski et al 39 41,60 Some series reported that preoperative chemotherapy could downstage the tumor and increase the resection rate, which may result in improved survival. 4,43,61,62 A retrospective study reported that patients with downstaged tumors after neoadjuvant chemotherapy experienced an improved survival compared to patients without response (P,0.001) and the lower rates of local recurrence (6% vs 13%, respectively; P=0.03) and systemic recurrence (19% vs 29%, respectively; P=0.027), and downstaging was the strongest independent predictor of survival.…”

Section: Neoadjuvant Chemotherapy and Surgery Vs Surgery Alonementioning

confidence: 99%

“…43 A meta-analysis reported by Gebski et al 39 41,60 Some series reported that preoperative chemotherapy could downstage the tumor and increase the resection rate, which may result in improved survival. 4,43,61,62 A retrospective study reported that patients with downstaged tumors after neoadjuvant chemotherapy experienced an improved survival compared to patients without response (P,0.001) and the lower rates of local recurrence (6% vs 13%, respectively; P=0.03) and systemic recurrence (19% vs 29%, respectively; P=0.027), and downstaging was the strongest independent predictor of survival. 61 The updated results of the randomized trial in the UK demonstrated macroscopic residual disease from incomplete resection (R2) or no resection in 26.4% of surgery vs 14.3% of the preoperative chemotherapy (P,0.001).…”

Section: Neoadjuvant Chemotherapy and Surgery Vs Surgery Alonementioning

confidence: 99%

“…4 A review also revealed that preoperative chemotherapy was associated with higher rates of R0 resection and more favorable tumor stage upon resection. 43 Some studies have demonstrated that preoperative chemotherapy would not increase serious postoperative complications for esophageal cancer. 56,60 A review and a meta-analysis also showed that preoperative chemotherapy for esophageal carcinoma did not increase the risk of postoperative morbidity or perioperative mortality compared to surgery alone.…”

Section: Neoadjuvant Chemotherapy and Surgery Vs Surgery Alonementioning

confidence: 99%

“…28,30 The number of positive lymph nodes could also be reduced with preoperative CRT, 28 which is associated with good survival. [41][42][43] Preoperative CRT significantly increases the pathologic complete response (pCR) rate, ranging from 18% to 43%. 27,30,33,[44][45][46][47][48][49] pCR is an independent favorable prognostic factor for survival after surgery 40,[50][51][52][53] and is also a favorable prognostic factor for both locoregional and systemic recurrences.…”

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Esophageal cancer: comparative effectiveness of treatment options

Cai¹,

Lin²

2016

CER

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Esophageal cancer is a lethal disease. Multimodal therapy has improved the survival and local control for locally advanced esophageal cancer compared to surgery alone. Neoadjuvant chemoradiotherapy (CRT) plus surgery is the accepted standard of care for operable esophageal cancer. Pathologic complete response is very common, ranging from 18% to 43%, and it is an independent favorable prognostic factor for survival. Salvage surgery after definitive CRT may be safe and feasible for patients with esophageal cancer who achieve pathologic complete response after neoadjuvant CRT. For inoperable cases, definitive CRT is an alternative treatment modality. Intensity-modulated radiation therapy may reduce treatment-related toxicities due to its better dose homogeneity and conformity compared to three-dimensional conformal radiotherapy. Proton therapy can further improve target conformity and normal tissue sparing when compared to photon therapy (three-dimensional conformal radiotherapy and intensitymodulated radiation therapy) and, therefore, likely to further improve the treatment outcomes of patients. This article compares the effectiveness of the various treatment approaches in the definitive or neoadjuvant setting and reviews the evidence on the benefit of utilizing advanced radiation techniques for the curative management of esophageal cancer.

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Preoperative Chemoradiotherapy vs Chemotherapy for Adenocarcinoma of the Esophagogastric Junction

Ronellenfitsch,

Friedrichs,

Barbier

et al. 2024

JAMA Netw Open

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ImportanceThe prognosis of patients with adenocarcinoma of the esophagus and esophagogastric junction (AEG) is poor. From current evidence, it remains unclear to what extent preoperative chemoradiotherapy (CRT) or preoperative and/or perioperative chemotherapy achieve better outcomes than surgery alone.ObjectiveTo assess the association of preoperative CRT and preoperative and/or perioperative chemotherapy in patients with AEG with overall survival and other outcomes.Data SourcesLiterature search in PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and International Clinical Trials Registry Platform was performed from inception to April 21, 2023.Study SelectionTwo blinded reviewers screened for randomized clinical trials comparing preoperative CRT plus surgery with preoperative and/or perioperative chemotherapy plus surgery, 1 intervention with surgery alone, or all 3 treatments. Only data from participants with AEG were included from trials that encompassed mixed histology or gastric cancer. Among 2768 initially identified studies, 17 (0.6%) met the selection criteria.Data Extraction and SynthesisThe Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed for extracting data and assessing data quality by 2 independent extractors. A bayesian network meta-analysis was conducted using the 2-stage approach.Main Outcomes and MeasuresOverall and disease-free survival, postoperative morbidity, and mortality.ResultsThe analyses included 2549 patients (2206 [86.5%] male; mean [SD] age, 61.0 [9.4] years) from 17 trials (conducted from 1989-2016). Both preoperative CRT plus surgery (hazard ratio [HR], 0.75 [95% credible interval (CrI), 0.62-0.90]; 3-year difference, 105 deaths per 1000 patients) and preoperative and/or perioperative chemotherapy plus surgery (HR, 0.78 [95% CrI, 0.64-0.91]; 3-year difference, 90 deaths per 1000 patients) showed longer overall survival than surgery alone. Comparing the 2 modalities yielded similar overall survival (HR, 1.04 [95% CrI], 0.83-1.28]; 3-year difference, 15 deaths per 1000 patients fewer for CRT). Similarly, disease-free survival was longer for both modalities compared with surgery alone. Postoperative morbidity was more frequent after CRT plus surgery (odds ratio [OR], 2.94 [95% CrI, 1.01-8.59]) than surgery alone. Postoperative mortality was not significantly more frequent after CRT plus surgery than surgery alone (OR, 2.50 [95% CrI, 0.66-10.56]) or after chemotherapy plus surgery than CRT plus surgery (OR, 0.44 [95% CrI, 0.08-2.00]).Conclusions and RelevanceIn this meta-analysis of patients with AEG, both preoperative CRT and preoperative and/or perioperative chemotherapy were associated with longer survival without relevant differences between the 2 modalities. Thus, either of the 2 treatments may be recommended to patients.

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Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus

Cited by 122 publications

References 58 publications

International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus

International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus

Esophageal cancer: comparative effectiveness of treatment options

Preoperative Chemoradiotherapy vs Chemotherapy for Adenocarcinoma of the Esophagogastric Junction

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