The optimal multimodal treatment strategy for resectable locally advanced oesophageal adenocarcinoma remains uncertain. A key question is whether perioperative chemotherapy offers better outcomes than preoperative chemoradiotherapy.
METHODS
The German, multi-centre, phase III ESOPEC trial randomised 221 patients with resectable oesophageal adenocarcinoma to receive perioperative chemotherapy with FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) plus surgery or preoperative chemoradiotherapy (41.4 Gy radiotherapy with carboplatin and paclitaxel) plus surgery. Eligible patients had primary tumours classified as cT1 cN+, cT2-4a cN+, or cT2-4a cN0, without evidence of metastatic spread. The primary endpoint was overall survival (OS).
RESULTS
At a median follow-up of 55 months, 3-year OS was higher in the FLOT group (compared to the preoperative chemoradiotherapy group (57.4% vs 50.7%; HR[95% CI]: 0.70[0.53-0.92], p= 0.01). Three-year progression-free survival was also improved in the FLOT group compared to the preoperative chemoradiotherapy group (51.6% vs 35.0%; HR[95% CI]: 0.66[0.51-0.85]. Grade ≥3 adverse events occurred in 58.0% of patients in the FLOT group and 50.0% in the chemoradiotherapy group, while serious adverse events were observed in 47.3% and 41.8%, respectively. Ninety-day postoperative mortality was 3.1% in the FLOT group and 5.6% in the preoperative chemoradiotherapy group.
CONCLUSIONS
Perioperative chemotherapy with FLOT significantly improved survival outcomes compared to preoperative chemoradiotherapy in patients with resectable oesophageal adenocarcinoma.
Reference
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