Annals of Surgical Oncology

, Volume 22, Supplement 3, pp 905–914 | Cite as

Influence of Different Neoadjuvant Chemotherapy Regimens on Response, Prognosis, and Complication Rate in Patients with Esophagogastric Adenocarcinoma

  • Christoph Springfeld
  • Christiane Wiecha
  • Romy Kunzmann
  • Ulrike Heger
  • Wilko Weichert
  • Rupert Langer
  • Annika Stange
  • Susanne Blank
  • Leila Sisic
  • Thomas Schmidt
  • Florian Lordick
  • Dirk Jäger
  • Lars Grenacher
  • Tom Bruckner
  • Markus W. Büchler
  • Katja Ott
Gastrointestinal Oncology

Abstract

Background

Perioperative chemotherapy improves survival in patients with advanced esophagogastric cancer, but the optimal treatment regimen remains unclear. More intensive chemotherapy may improve outcome, but also increase toxicity and complications.

Methods

A total of 843 patients were included in this retrospective study and stratified in 4 groups: doublet therapy with cisplatin or oxaliplatin and 5-fluorouracil (groups A/B) or triplet therapy with additional epirubicin or taxane (groups C/D). The influence of the different neoadjuvant chemotherapy regimens on response, prognosis, and complications was assessed.

Results

Clinical and pathological response were associated with longer overall survival (OS; p < 0.001). No significant differences regarding response or OS were found, but there was a trend toward better outcome in group D (taxane-containing triplet). In the subgroup of 669 patients with adenocarcinomas of the esophagogastric junction (AEG), patients who had received taxane-containing regimens had a significantly longer OS (p = 0.037), but taxane use was not an independent factor in multivariate analysis. Triple therapy with taxanes did not result in a higher complication rate or postoperative mortality.

Conclusions

Although no superior neoadjuvant chemotherapy regimen was identified for patients with esophagogastric adenocarcinoma, taxane-containing regimens should be further investigated in randomized trials, especially in patients with AEG tumors.

Keywords

Gastric Cancer Overall Survival Oxaliplatin Epirubicin Good Clinical Response 

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Christoph Springfeld
    • 1
  • Christiane Wiecha
    • 2
  • Romy Kunzmann
    • 2
  • Ulrike Heger
    • 2
  • Wilko Weichert
    • 3
  • Rupert Langer
    • 4
  • Annika Stange
    • 1
  • Susanne Blank
    • 2
  • Leila Sisic
    • 2
  • Thomas Schmidt
    • 2
  • Florian Lordick
    • 5
  • Dirk Jäger
    • 1
  • Lars Grenacher
    • 6
  • Tom Bruckner
    • 7
  • Markus W. Büchler
    • 2
  • Katja Ott
    • 2
    • 8
  1. 1.Department of Medical Oncology, National Center for Tumor DiseasesHeidelberg University HospitalHeidelbergGermany
  2. 2.Department of SurgeryHeidelberg University HospitalHeidelbergGermany
  3. 3.Department of PathologyHeidelberg University HospitalHeidelbergGermany
  4. 4.Institute for PathologyUniversity of BernBernSwitzerland
  5. 5.University Cancer Center LeipzigLeipzigGermany
  6. 6.Diagnostic and Interventional RadiologyHeidelberg University HospitalHeidelbergGermany
  7. 7.Institute of Medical Biometry and InformaticsHeidelberg University HospitalHeidelbergGermany
  8. 8.Klinik für Allgemein-, Gefäß-, und ThoraxchirurgieRoMed Klinikum RosenheimRosenheimGermany

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